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SEPTEMBER / OCTOBER 2012 :: 73(5)
Social Determinants of Health

This issue's policy forum focuses on key social determinants of health. Authors explore how health is linked with education, poverty, and housing, and discuss the role of neighborhoods and health disparities in shaping individual health status. Complementary sidebar articles describe effective and promising interventions occurring throughout the state to address these social determinants of health. Original articles examine the state of racial/ethnic diversity in North Carolina's health workforce and review dental visits to an emergency department in the state.


The Youth in Transition Community Initiative of Forsyth County

Scott F. Wierman

N C Med J. 2012;73(5):407-408.PDF | TABLE OF CONTENTS

In 2009, a new community issue came to the attention of the Winston-Salem Foundation — the plight of young people who age out of foster care. As the Forsyth County Department of Social Services explained to the Foundation, the services provided for young people once they turn 18 are not adequate to meet their needs. There are provisions to provide supportive transitional programs and even Medicaid until they are 21. However, many of these young people feel they do not need or want ongoing child welfare services. Inevitably this means they may find themselves living alone without any support, trying to make it with few or no resources, and facing difficult life challenges without the guidance of a stable family or the networks that can support healthy development.

The Foundation understood that the community was losing the potential of these young people. Additionally, national studies show that young people transitioning from foster care without a support network are 20% more likely to become homeless, and also face higher rates of unemployment, criminal conviction, public assistance, and single parenthood [1, 2]. In fact, national statistics show only half are employed at age 24, 71% of the young women are pregnant by age 21, and fewer than 3% will earn a college degree by age 25 (as compared to 28% of all 25 year olds), and 1 in 4 will be involved in the criminal justice system within 2 years of leaving the foster care system [2, 3].

Those national statistics also reflected what Forsyth County was experiencing, but the Foundation felt the problems could be improved upon because there were resources available in the community. In addition, the number of young people was small enough to be manageable; between 2002-2008, there were only 149 young people who aged out of the system in Forsyth County.

The Winston-Salem Foundation agreed to serve as the convener and brought together a diverse group of community representatives including the Kate B. Reynolds Charitable Trust, the Forsyth County Department of Social Services, The Children’s Home, Goodwill Industries of Northwest North Carolina, and individuals who had expertise in developing programs for young people or who had connections to local resources. The group also was committed to including youth previously in foster care as well as those currently in the system.

Working together, this community consortium began to identify the challenges facing young people transitioning from foster care, researching the resources that currently exist, and identifying the gaps that needed to be filled. The goal was to develop a comprehensive community plan designed to improve the chances of success for these young people ages 18-25. In 2010, the Youth in Transition Community Initiative of Forsyth County (YIT) was born, with technical support provided by the Jim Casey Youth Opportunities Initiative, a non-profit national organization that works locally in a number of sites across the US to create opportunities that will improve the lives of young people.

While YIT is a cooperative effort, the group believed there needed to be one lead agency and selected Goodwill Industries of Northwest North Carolina to fill that role, based on the organization’s resources and experiences in implementing supportive youth programs in areas that parallel YIT’s objectives such as mentoring, housing support, financial literacy, and job training. Goodwill also had a strong track record of developing partnerships with other resources in the community to provide these services.

Based on advice provided by the Jim Casey Youth Opportunities Initiative, YIT began an early focus on financial literacy since many of the young people had little or no knowledge of how to budget or manage money. The staff also supported the young people by working with them to overcome any barriers to participation they might have such as transportation to the sessions.

One of the key elements for the Initiative had to be the inclusion of young people in identifying needs and developing avenues to meet those needs. Leading Youth for Empowerment (LYFE), is the youth leadership board that allows the young people involved in YIT to have a voice and to develop their own network of supportive peers. One of their first tasks was to develop a list of priorities that needed to be addressed if they were to be successful in their development. Not surprisingly, the first priority was employment, followed closely by housing. These young people who were on their own needed an income and a stable place to live if they were to take advantage of the opportunities the community could provide them. While a job, a place to live, the ability to meet daily needs, and the ability to save money are certainly common priorities for most young people, the LYFE group did have a priority that was uniquely related to foster care, and that was being able to visit their younger siblings.

Organizations that have some of the necessary resources have been stepping up as partners with YIT to help meet all of these priorities. Forsyth Technical Community College is working to provide educational opportunities and mentoring, the local YMCA has agreed to hire YIT participants as counselors, and Goodwill’s eLink program is providing job readiness training. The North Carolina Housing Foundation is partnering with YIT to identify temporary and long-term housing while the partnership created by Consumer Credit Counseling Services, the Forsyth County Department of Social Services, and Allegacy Federal Credit Union is working to provide financial literacy classes and to enroll participants in the Individual Development Account Program that allows participants to have their savings matched for education, housing, transportation, and other necessities.

While YIT has not yet completed all of the work necessary to support its goals, much progress has been made in the past 2 years. Importantly, 43 young people have some type of involvement in the Initiative. Of these, 12 of the young people completed financial literacy training, and 11 are currently enrolled. YIT staff has assisted 9 youth with housing, 10 with transportation needs, and 3 with obtaining a Social Security card. A practice model is nearly completed and, from that, the final research and evaluation tools will be developed. The evaluation component is not only important to funders, but also to strategic programmatic direction.

The framework that has been developed will allow YIT to expand its ability to determine gaps in services and to develop a more seamless relationship with the Department of Social Services that will ensure better support for the young people being served and lessen any possibility of expending resources on redundant efforts. Through the relationship with the Department, efforts will be made to reach a younger audience so that the youth transitioning from foster care 5 years from now will be much better prepared to live on their own.

With national program support from the Jim Casey Youth Opportunities Initiative ( and local community organizations coming together with the young people they were trying to serve, The Duke Endowment provided a 2-year grant of $594,793 to support the Initiative and the Kate B. Reynolds Charitable Trust has provided a 3-year grant of $486,565 that will provide matching funds for the Individual Development Accounts as well as support financial literacy efforts. This funding has provided a foundation on which YIT can continue to build its programming and its reach in the community.

As those involved in the Initiative acknowledge and agree, this is not an issue that could be solved by the efforts of any one agency or organization. Bringing together a community collaborative to work hand-in-hand with the youth themselves will make a difference for the young people aging out of foster care and for the broader community.

Potential conflicts of interest. S.F.W. has no relevant conflicts of interest.

1. Casey Family Programs. Northwest Foster Care Alumni Study. Seattle, WA: Casey Family Programs; 1998.

2. Pecora PJ, Kessler RC, Williams J, et al. Improving Family Foster Care: Findings from the Northwest Foster Care Alumni Study. Seattle, WA: Casey Family Programs; 2005.

3. Courtney ME, Dworsky A, Ruth G, Keller T, Havlicek J, Bost N. Midwest Evaluation of the Adult Functioning of Former Foster Youth: Outcomes at Age 19. Chicago, IL: Chapin Hall Center for Children at the University of Chicago; 2005.

Scott F. Wierman president, The Winston-Salem Foundation, Winston-Salem, North Carolina.

Address correspondence to Mr. Scott F. Wierman, 860 West Fifth Street, Winston-Salem, North Carolina 27101 (