JAMA Forum: Engaging “Disconnected” Youths to Prevent Lives of Isolation, Poverty, and Ill Health*

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Consider a group of young US residents who are considered “disconnected youth”—the nearly 12% of people between the ages of 16 and 24 years who are neither enrolled in school nor employed. If young people lack support from family or mentors to face the developmental challenges of transitioning to adulthood, or if they haven’t acquired the skills necessary for successful employment, they are at risk for a life of isolation, poverty, and poor health.

The extent of disconnected youth is one indicator of a community’s health. Measure of America (MoA), a nonprofit project of the Social Science Research Council, added this concept to its measures in 2009, using data from the US Census Bureau’s American Community Survey (ACS). The University of Wisconsin’s County Health Rankings now includes it as a key health indicator.

The rate of disconnected US youth, 3.9% in 1999, increased to 14.7% in 2010, likely as a result of the recession. While the rate has decreased since then, there are still 4.6 million youth who are considered disconnected. The highest rates are in rural areas, where the rates by county vary from 0% to 76.6%. In in Delaware County, New York, where my upstate home is located, 27% of children live in poverty and 16% of those 16 to 24 years old are disconnected. These rates don’t reflect young people who are homeless, incarcerated, or otherwise uncounted in the ACS. Nor do they encompass the disconnection of young people who are working or in school, but marginally so.

Delaware County, like many rural communities, has struggled to address opioid addiction. I volunteered to facilitate a newly formed Eastern Delaware County Coalition on Substance Abuse Prevention and Treatment (EDCC). We engaged school-aged children in a photo project, called My Community, in which they submitted photos showing what they liked and didn’t like about the community. They also participated in an EDCC-sponsored summit on addiction prevention and treatment in January. The work is just beginning, but we’ve already begun to address issues such as transportation that will require a public-private partnership to enable youth to access activities outside of school and recovery services.

Why Disconnection Matters

Compared with youth in their age cohort who are still in school or working, disconnected youth are more likely to have parents with low education levels and to be poor, drop out of high school, become teenage mothers, and be incarcerated. They also are at higher risk than connected youth for mental health problems, including substance use disorders.

Measure of America analyzed data from University of Michigan’s Panel Study of Income Dynamics, comparing youth 5, 10, and 15 years after their disconnection period with those who had remained connected. After 14 years, those who had remained connected were 52% more likely to report good or excellent health and 42% more likely to have completed some college, be employed, and earn $31 000 more a year.

The effect of youth disconnection is also felt by the communities where they reside and by society as a whole. Two Futures, a 2018 report on youth disconnection by MoA, notes: “The negative effects of youth disconnection ricochet across the economy, the social sector, the criminal justice system, and the political landscape, affecting all Americans, not just now but also in the next generation.” Disconnected young people are unlikely to learn effective parenting skills or to navigate out of a life of poverty and ill health as adults. Indeed, they are more likely to be recipients of Medicaid and other public supports.

The highest rates of disconnection are among Native American (25.8%) and African American (17.2%) youth, compared with 9.2% of white youth, highlighting the influence of social factors such as intergenerational poverty and racism. An economic analysis based on 6.7 million disconnected youth in 2011 concluded that the full lifetime burden of disconnected youth in lost taxes, lost productivity, health care (including addiction treatment), social services, criminal justice expenditures, and other public spending was $4.7 trillion. An investment in youth engagement, including mentored work-training programs, can have large returns on investments for communities.

What Works to Reconnect and Prevent Disconnection

Disconnected youth are also referred to as “opportunity youth,” a term that positively reframes the concept. A 2012 report uses this language to illustrate that communities can engage youth in meaningful ways to prevent or address disconnection. Communities first and foremost must actively solicit the perspectives of their young people on meaningful engagement and involve them in designing interventions that work.

Family dynamics and parenting skills, schools, and access to transportation and community activities all affect young people. At the EDCC community summit, the youth participants said they wanted more opportunities for engagement, including a youth center and employment training programs. We learned that YouthBuild Utica, a program focused on construction jobs in Utica, NY, mentored and trained youth to remodel housing units and an outreach center for homeless veterans while earning their General Education Diploma and a certification in construction. The youth, who are paid for their work, go on to college or to stable jobs in the community. However, ongoing funding for the program remains a challenge.

A clear, coordinated community focus on youth engagement is essential, similar to what colleges provide to students. One goal in providing such services must be to reduce fragmentation and inefficiencies for better results. For instance, what can be done to help identify at-risk youth , as well as to monitor what’s working and track young people in education, criminal justice, foster care, and health care? Databases have to be interoperable to ensure focused, coordinated efforts. Performance Partnership Pilots for Disconnected Youth is a federal initiative included in the Consolidated Appropriations Act of 2014 that provides state, local, and tribal communities flexibility in the use of federal discretionary funds and the opportunity to blend these funds from different federal agencies to test best practices. State and local governments could create similar initiatives.

Mentoring for Connection

Having an adult mentor is a key to both preventing disconnection and reengaging youth. Mentorship is featured in many successful programs targeting at-risk young people. But it’s incumbent upon all of us to mentor the next generation of community leaders and members.

*This blog post has been updated to reflect new information.

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About the AuthorDiana J. Mason, PhD, RN, is Senior Policy Service Professor at George Washington University School of Nursing’s Center for Health Policy and Media Engagement and Professor Emerita at Hunter College, City University of New York. She currently serves as a member of the board of directors of Public Health Solutions. She is a former president of the American Academy of Nursing. (Image: Ted Grudzinski/AMA)

 

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

 



Categories: Addiction Medicine, Health Policy, Psychosocial Issues, The JAMA Forum

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