The System Is Failing Our Kids: How to Rebuild Child Welfare from the Inside Out, with Nicole Six, VP of Product Development at Centene

If Teens Won’t Engage, Nothing Else Matters. Marc Fagan on Youth Voice, Peer Support, and Systems That Actually Work

What really moves the needle for transition-age youth (16–24)? It’s not another program list—it’s engagement. In this episode, Patrick sits down with Marc Fagan, President of YouthCare Illinois, to unpack a new playbook: put youth voice on the mic, design for discovery (not lectures), make peer support core infrastructure, and measure uptake instead of offerings. Who this is for: Medicaid leaders, child-welfare teams, providers, school partners, policymakers, and anyone building youth programs that need to work in the real world. You’ll learn: * Why “listening” (for real) is the biggest shift since 2015 * How to win the first yes from the least-likely-to-engage population * Where peer support and community fit alongside therapy * How to design discovery-oriented care—healthy risk with real safety nets * The role of virtual touchpoints, SDOH (jobs/school), and what to measure next Chapters 00:00 Cold open — quick banter & setup 00:27 Who is Marc Fagan & what YouthCare does 01:08 Why Marc chose clinical psychology 01:57 Therapeutic schools: the power of relational work 03:10 From 1:1 therapy to systems design 04:13 Story: a student turns classroom chaos into graduation 06:26 Scaling impact beyond one campus 09:06 Thresholds highlights: youth homelessness program 10:27 Launching First Episode Psychosis care in Illinois 12:14 Why early intervention changes the arc 13:24 Then vs now: outcomes and accountability 14:39 What “transition-age youth” actually need (and don’t get) 16:06 2025’s biggest shift: youth voice leads 17:47 What teens keep telling us (and how adults should respond) 18:15 Discovery-oriented care: learning by doing, with guardrails 20:20 Design for exploration, not lectures 21:21 YouthCare’s population: youth with child-welfare histories 22:51 Virtual touchpoints & continuity across placements 24:00 Beyond therapy: groups, play/animal therapy, peer support 25:07 The pivot: from mostly clinical to mostly social 26:10 Multidisciplinary models that actually stick 27:02 The engagement problem—and how to solve it 28:04 Training staff to earn the first yes 29:10 Measuring what matters: uptake, not inventory 29:37 SDOH in practice: jobs, school, first opportunities 31:25 Early jobs and lessons (including a data-entry horror story) 33:01 Leadership: excitement, ownership, youth focus groups 34:40 Preventing burnout: celebrate small wins 38:05 The next 10–15 years: risk, policy, connection 40:07 Hopes for the future: faster access, shorter time in care 42:02 Biggest levers: tech plumbing + nontraditional care 44:11 Why relationships still beat everything 44:52 Showing up authentically (yes, there was a dance-off) 46:13 What keeps Marc optimistic 48:25 Where to learn more about YouthCare 49:14 One snap: immediate access + one committed adult 50:01 Closing If this was useful, please like, subscribe, and share with someone building for youth. If you or someone you know is in crisis, call or text 988 (U.S.).

Mental Health Isn’t “Cool.” Here’s How We Designed Around That

What makes a teen mental health product worth opening every day? In this episode of Self Disclosed, Somethings’ design team walks through the choices behind our new brand and product: why we center connection before anything else, how we keep teens in the driver’s seat, and why our visual system embraces graffiti over clinical calm. We also share how we use AI as a quiet assist for mentors rather than a chatbot on the front line, and the naming story behind Somethings. You will learn * The core problem we see behind the stats: loneliness * How to design for trust, agency, and real conversation * Why a teen-facing brand should feel expressive, not pastel and clinical * Where AI helps humans show up better, and where it does not * The origin of our name and why words matter to teens Chapters 00:00 Cold open and why design matters in youth mental health 01:58 Meet the team and backgrounds 03:56 First designer’s path from pro sports to product 05:46 Our design philosophy: build with teens, not for them 07:06 What we hear every day: loneliness is the through-line 08:32 Teens can say more than adults think, if you listen 10:37 How adult minimization harms trust 11:54 Designing for genuine connection and rapport 15:50 Our AI stance: support mentors, do not replace them 19:43 Features that help mentors remember, follow up, and be present 20:50 A different approach to product and brand in mental health 21:27 What most teen mental health brands miss 23:37 Can mental health feel “cool” and authentic 25:16 Launching the new brand 27:44 Why graffiti, not fog and pastels 29:21 Empowering teen self-expression on purpose 31:32 Keeping the brand a mirror to teen life 33:23 Bringing brand principles into product decisions 35:59 What excites us about the next chapter 38:33 Why we are called Somethings 45:27 Final thoughts and how to get involved If this was useful, like and subscribe, and share it with someone building for teens.

Does Digital Peer Support Work for Teens? Inside North Carolina’s Real-World Results

In this episode of Self Disclosed, we open up Somethings’ first clinical outcomes report from our statewide rollout in North Carolina and talk plainly about what changed for teens, how we measured it, and what it means for families, schools, payers, and states. What this episode covers - What Somethings is: a youth mental health app that pairs teens (13–26) with certified peer mentors for on-demand support and continuity of relationship- Why North Carolina partnered to offer the program free to ~1.2M teens across all 100 counties- How we evaluated impact (pre–post design; PHQ-8, GAD-7, WHO-5, ASQ-3)- Engagement at scale, rural access, and why human connection beats chatbots for this age group- What the data says about depression, anxiety, well-being, and suicidal ideation- Where this fits in the care ecosystem (ED diversion, continuity, cost, and appropriate utilization) Key findings (real-world, not a lab)- Average time from sign-up to first connection: ~6 hours- In about 2 months: 77% of teens improved in at least one domain; 52% showed clinically meaningful improvement; nearly 1 in 4 reached remission in at least one area- Teens who started with suicidal thoughts: prevalence dropped from ~40% at intake to ~27% at follow-up; median time to resolution = 16 days- Who we served: a high-need, diverse population with common moderate-to-severe symptoms, including many youth who struggle to access traditional care Who should watch Parents and educators, Medicaid and health-plan leaders, state and county health officials, school mental-health teams, clinicians, and builders who need evidence on what actually engages teens and moves outcomes. Chapters 00:00 Intro and why we recorded this 00:50 Meet the team 05:06 What Somethings does and why peers matter 06:50 North Carolina partnership overview 08:19 Study design and measures (PHQ-8, GAD-7, WHO-5, ASQ-3) 11:01 Who we served and why access matters 12:16 Engagement metrics and 6-hour time to first connection 13:11 Baseline risk: depression, anxiety, suicidal ideation 15:32 Outcomes at ~2 months: improvement, clinical change, remission 16:45 Why rapport is the intervention 19:51 Depression results, then anxiety and well-being 22:58 Suicidal ideation: resolution timeline and impact 26:38 “Teens are not little adults” and system navigation 29:42 Why many teens drop out of treatment and how peers help 33:31 ER boarding, cost, and appropriate utilization 36:34 Rural access and continuity in the real world 38:19 Case study from the field 41:13 Making support more accessible for different learners 41:58 What health plans and states can do right now 42:55 Rapid-fire: one change we’d make for youth mental health 45:59 Closing thoughts This is a real-world, pre–post outcomes evaluation, not medical advice. If you or someone you know is in crisis, call or text 988 in the U.S.

The System Is Failing Our Kids: How to Rebuild Child Welfare from the Inside Out, with Nicole Six, VP of Product Development at Centene

What if the system built to protect children is also the one traumatizing them? Nicole Six — VP of Product Development at Sentara Health and a licensed clinical social worker — has spent her career inside the child welfare and behavioral health systems. From her early days as a social worker in New York City to leading large-scale Medicaid and child welfare initiatives in North Carolina, Nicole has seen how policy, poverty, and broken systems collide to shape the lives of vulnerable kids. In this powerful conversation, she and Patrick Gilligan dive into what’s working, what’s failing, and what needs to change — now. You’ll hear: - Why children in foster care lose connection to their families and communities the longer they’re in care - The painful truth that “we created the trauma” for many of the kids our systems claim to protect - Why the best clinicians are leaving behavioral health — and how that’s quietly deepening the access crisis - The case for upstream prevention and family-centered care - What a transformed child welfare system could look like by 2030 - And the one thing Nicole says every child needs most: someone who loves them. This episode is raw, eye-opening, and deeply human. If you care about child welfare, mental health, or Medicaid reform — you need to hear this one. Timestamps 00:00 – Introduction 02:00 – Nicole’s path from social work to leadership 07:00 – Lessons from child welfare in NYC vs. North Carolina 13:00 – Why prevention is everything — and why it’s underfunded 17:00 – The myth of “bad families” and what kids really need 24:00 – The mental health access crisis and why clinicians are leaving 30:00 – How to design systems that actually help families 36:00 – What a trauma-informed future could look like 40:00 – Why kids in care lose their connection to “their people” 43:00 – The hard truth: we created the trauma we’re trying to fix 48:00 – The one thing Nicole wishes every child could have

Building Community-Wide Systems of Care to Support At-Risk Youth, with Christine Beck, Executive Director of Behavioral Health at Optum

Too many kids in crisis end up stuck in emergency rooms. Not because they need to be there, but because the system doesn’t know what else to do. Christine Beck, Executive Director of Behavioral Health at Optum UHC (NC Medicaid), has spent her career changing that reality. From her early days listening to foster youth no one else would hear, to launching pilots that reshaped North Carolina’s crisis response, to leading statewide Medicaid behavioral health today, Christine brings both the heart of a clinician and the vision of a systems builder. In this conversation, we dive into the programs that worked, the lessons from pilots that scaled statewide, and what it will take to build trauma-informed systems that actually keep kids safe, supported, and at home. Timestamps 00:00 – Introduction 02:00 – Christine’s first internship: seeing foster youth overlooked 04:00 – The moment she realized kids just needed someone to listen 06:00 – Why foster parents need wraparound support to succeed 09:30 – Piloting crisis diversion: keeping kids out of the ER 11:30 – How NC’s “MORC” model grew from those pilots 13:30 – Building provider and hospital alignment around crisis response 15:00 – The evolution of NC Medicaid: waivers, tailored plans, specialty plans 18:00 – Standard plans vs. tailored plans: prevention vs. specialty care 21:00 – Investing in school-based health and prevention 22:30 – Tackling stigma in mental health 24:00 – Training first responders to respond differently 30:00 – Scaling programs statewide: why change moves too slow 32:00 – The workforce shortage: using peers and community health workers 35:00 – Making data useful (without drowning in it) 38:30 – Programs that exceeded expectations: families staying together 40:30 – What trauma-informed systems look like 43:00 – The next big domino in crisis response 45:00 – Being the clinical voice inside a large insurer 48:00 – The career pivot that changed everything 49:30 – If Christine could snap her fingers and fix one thing in youth mental health…