I’ve been quiet.

April came and went, and I didn’t publish.

Not because I ran out of ideas.
Not because I lacked discipline.

Because life has been life-ing.

2025 didn’t just challenge me ~ it escalated every single month.

January opened with spinal surgery to remove two large masses.
December closed with my mother’s death.

Between those?

Six additional surgeries. A body relearning how to exist.
A nervous system trying to stabilize itself in real time.

Then 2026 said: you thought we were done?

Days after returning from my mother’s end-of-life service, my employer denied my disability accommodations and terminated my position.

Unemployment in this state? 12 weeks. That ended in March.
That same month, I asked family for help. Two remaining biological relatives.

One responded with silence I expected.
The other responded with silence that broke something.

So no ~ didn’t get a newsletter. April got survival.
BTW, Happy Foster Care Awareness Month!

Now let’s talk about these fckn “bootstraps”

Because apparently, I’m supposed to pull myself up by them.

The phrase “pull yourself up by your bootstraps” originated in the 19th century as a metaphor for an impossible act—lifting yourself off the ground by your own boots (Oxford English Dictionary, n.d.; Safire, 2008).

That was the point.

It meant: This cannot be done.
And yet today, it’s used as policy logic.

What I was told to do ~ and what I actually did

I did everything right.

• Worked 3 jobs while in school full-time

• Earned a Master’s and a Doctorate

• Won national and international awards

• Presented research globally

• Built interventions grounded in lived experience and science

• Started job searching 2 years before graduating

This is what “bootstraps” is supposed to look like.

And yet ~ I am

• Terminated after requesting disability accommodations

• Living with Secondary Adrenal Insufficiency

• Managing chronic pain from spinal surgery and nerve regrowth in my lower back

• Navigating a new larger than average kidney stone in the same kidney that nearly killed me last year

• Fainting at physically demanding jobs (again) I should never have needed to take

• Watching science jobs disappear as funding contracts

• Being told I’m “not a fit” for roles I am overqualified for

At one point, I was assumed to be mentally unstable ~ until they Googled me.
“Holy shit, she’s the real deal.”

And still: no.


On “Who You Know” (and why that advice has limits)

I’ve been told ~ repeatedly ~ that success is about “who you know.”
Fine.
So I did that too.
I introduced myself in rooms where I didn’t belong yet.
I went to conferences, societies, events, cold conversations ~ sometimes awkward, always intentional ~ because I understood the assignment: proximity creates opportunity.
But here’s the part people don’t say out loud:
’access to networks is not the same as acceptance within them.’
I’ve been called overqualified in one breath and treated like a fraud in the next.
I’ve had headhunters pursue me as a “top candidate,” only for clients to quietly pass after a single glance at my profile. I’ve had organizations verify my credentials ~ degrees, awards, publications ~ and still choose less qualified candidates without even a conversation.
So no, this isn’t a lack of effort, awareness, or strategy.
This is what happens when “who you know” runs headfirst into bias, discomfort, and systems that don’t know what to do with someone who doesn’t fit their expectations. Networking works ~ but not equally, and not for everyone.

For those who think this is just my story ~ read the data

Black women and unemployment (2026 reality check)

• U.S. Bureau of Labor Statistics
  https://www.bls.gov/web/empsit/cpsee_e16.htm

• Economic Policy Institute
  https://www.epi.org/indicators/state-unemployment-race-ethnicity/

The latest labor data continues to show:

• Black workers ~ Black women ~ experience higher unemployment rates than white workers, even at similar education levels (BLS, 2026; EPI, 2026).

• These disparities persist across economic cycles, reflecting structural inequity rather than individual behavior (Wilson, 2023).

• Black women are more likely to be concentrated in lower-wage, less stable roles, increasing vulnerability when sectors contract (National Women’s Law Center [NWLC], 2024).

Science and public health jobs are shrinking

• National Institutes of Health

• Centers for Disease Control and Prevention

• Association of Schools and Programs of Public Health

Funding constraints → fewer grants / research → fewer contracts → fewer jobs.
Public health didn’t become less necessary.

It became less funded.

Public health workforce instability

• Kaiser Family Foundation

• Health Affairs

After being labeled “essential,” the workforce has been:

• underfunded

• burned out

• politically targeted

• pushed out

About “just report it” ~ the EEOC reality

People say:
“File a complaint.”
“Take legal action.”

Let’s ground that.

• U.S. Equal Employment Opportunity Commission

The EEOC receives tens of thousands of cases each year.

Many are:

• closed without a finding

• delayed for months to years

Independent reporting from NPR highlights:

• case backlogs

• limited resources

• enforcement constraints

Filing is not wrong. But it is not simple, fast, or accessible for people already in crisis.
Also, this is a part of new reality: https://www.npr.org/2026/03/31/nx-s1-5763966/eeoc-trump-white-men-civil-rights-dei-discrimination

MAY is Foster Care Awareness Month:
The “Bootstraps” Myth Meets Foster Care Reality

Now layer this onto foster care.

Social Determinants of Health (SDoH) are the conditions shaping life outcomes

(World Health Organization, 2008)

Economic Stability

Former foster youth face high unemployment and poverty (Courtney et al., 2011). Bootstraps require income.

Education Access

Only ~3–4% earn bachelor’s degrees (National Foster Youth Institute, 2020).
Even when we succeed? We are still blocked.

Healthcare Access

Chronic conditions are common.
Continuity of care is rare ~ especially when on Medicaid that dosen’t cover everything, even when you are unemployed, with a potential life threatening illness.

Bootstraps don’t regulate cortisol.

Social Support

Family instability removes safety nets. Not everyone is born with a stable family foundation. Crisis hits harder.

Housing Stability

Up to 36% experience homelessness by age 26 (Courtney et al., 2011)
Try “pulling yourself up” when you are unemployed due to no fault of your own, no family to assist, no income to cover the cost of your medicine, and the local available resources only help you with issues of homelessness AFTER you’ve been DOCUMENTED as UNHOUSED for at least ONE YEAR. How can one PREVENT homelessness when you are in my position - and every available resource MAY only grant you entry into a program AFTER ONE YEAR of being homeless (so long as someone ELSE has it written down somewhere) ?

Let’s translate the modern version of the metaphor properly

You’re told: “Pull yourself up by your bootstraps.”

Reality:

• No boots

• No stable ground

• Systems cutting the laces

Then: “You’re not trying hard enough.”

The Black Tax

Black workers must outperform to be considered equal (Bertrand & Mullainathan, 2004).

I did.

Still excluded.

This is not a motivation problem

This is:

• labour economics

• structural racism

• ableism

• policy failure

• and institutional erosion (especially from the federal level)

What I actually need

Not motivation. Not metaphors.

I need:

• accessible, low-physical-strain work

• systems that recognize expertise

• healthcare that adapts to real life

• policies that fund the fields they told us to enter

Final thought

If bootstraps worked ~ I would be your success story.
Instead, I’m your evidence that the model is broken, or reality is being ignored for an entire population.

And yet ~ I’m still here

Not because the system works.
But because I refuse to disappear.


Thank you again for taking the time to read this lived experience update.
I sincerely hope it has helped you consider a different point of view or may relate to someone you know.

Feel free to forward it to someone who might benefit from these newsletters.

Please support me and this work by subscribing and/or helping me cover the cost of my medication below:

Pls Help Cover My Meds!

Ta for now,
Doc Sunshine

References (APA)

Bertrand, M., & Mullainathan, S. (2004). American Economic Review, 94(4), 991–1013.

Courtney, M. E., et al. (2011). Midwest evaluation of foster youth.

Economic Policy Institute. (2026).

Equal Employment Opportunity Commission. (2024).

Health Affairs. (2023).

Kaiser Family Foundation. (2024).

National Women’s Law Center. (2024).

National Foster Youth Institute. (2020).

National Institutes of Health. (2025).

NPR. (2024).

Oxford English Dictionary. (n.d.).

Safire, W. (2008).

U.S. Bureau of Labor Statistics. (2026).

World Health Organization. (2008).

Wilson, V. (2023).

In previous newsletter, I mentioned the challenges I’ve found with ACEs (Adverse Childhood Experiences) it’s limitations as well as my researched recommendations to make them more accurate and equitable for real-life populations. I also mentioned in other newsletters - here and here - about my lived experiences in foster care, as well as the subsequent impacts spanning into adulthood in terms of social determinants of health (factors outside the body that influence health). We talk about childhood trauma as something that changes behavior, coping, or mental health.
But biology doesn’t make that distinction. The body keeps score too — especially the stress system.

The stress system, in plain language

Think of the stress system like an emergency response chain:

• Hypothalamus = the dispatcher (detects threat)

• Pituitary = the manager (issues orders to the adrenal glands)

• Adrenal glands = the factory (produces cortisol)

• Cortisol = both fuel and brakes

  It gives you energy and tells the body when to stand down.

When this system works, stress rises when it’s needed — and shuts off when it’s safe.

Trauma can reshape the stress system

Research on childhood adversity and trauma shows something consistent:

Chronic threat exposure can recalibrate how the HPA axis functions.

Not necessarily higher cortisol forever. Often the opposite.
After years of repeated activation, the system can become blunted, quieter, less responsive. This is sometimes described as allostatic load — also referred to as “wear and tear”, the cost of keeping the alarm on for too long.

Alarm stuck on → alarm wears down.

That doesn’t mean “nothing happens.”
It means the body learns to conserve, suppress, or misread signals.

This matters deeply for foster youth — especially Black and Brown children

Now imagine a child in the foster care system:

• Repeated placement changes

• Unpredictable caregivers

• Surveillance instead of safety

• Racialized stress layered on top of instability

The JAMA Network Open study my advisor recently shared with me, titled: ‘Cumulative Lifespan Stress, Inflammation, and Racial Disparities in Mortality Between Black and White Adults’ (doi:10.1001/jamanetworkopen.2025.54701) strengthens an essential point:

Cumulative stress exposure becomes biology.

That paper shows how lifelong stress — disproportionately borne by Black individuals — is linked to inflammation and higher mortality later in life.
Not because of “choices.” Because stress embeds itself physiologically.

This doesn’t prove adrenal insufficiency.
But it does prove that chronic stress leaves biological scars that last decades.

So where does Secondary Adrenal Insufficiency (SAI) fit?

This is where precision matters.
SAI is not “being stressed.”

It’s a clinical hormone deficiency — caused by insufficient signaling from the hypothalamus or pituitary (low CRH / ACTH), often due to:

• Pituitary disease or injury (specifically my case = SAI)

• Suppression from long-term steroid exposure (tertiary adrenal insufficiency = TAI)

• Structural or functional hypothalamic–pituitary disruption

So here’s the honest statement — and it’s powerful because it’s honest:
Trauma alone has not been proven to cause SAI.

And yet:

Trauma can reshape the signaling system that SAI depends on.

The hypothesis bridge

The plausible bridge looks like this:

• Chronic childhood stress recalibrates HPA signaling

• Recalibration may produce fragile, blunted, or masked responses

• That fragility may matter when other insults occur

  (steroids, illness, pituitary changes, inflammatory burden)

Not a single cause.
A stacked vulnerability.
This is not a courtroom story. It’s a physiology story.

Why this question matters

Medicine often measures:

• One cortisol value

• One ACTH test

• One moment in time

But it rarely measures:

• Patterns

• Lived stress load

• Years of adaptive suppression

• Who had to stay alert to survive childhood

My question really isn’t:

“Did trauma cause my SAI?”

My question is far more uncomfortable — and far more important:

“What did my body have to become, long before anyone was measuring it?”

And that is a question medicine still isn’t equipped to answer — especially for Black and Brown children whose stress was never treated as a biological exposure in the first place.

Clinician Sidebar: What This Does Not Prove

This discussion does not claim that childhood trauma or adverse experiences cause Secondary Adrenal Insufficiency (SAI) in isolation. Current clinical evidence supports SAI as a disorder of hypothalamic–pituitary signaling, most commonly associated with pituitary pathology, hypothalamic dysfunction, or suppression following exogenous glucocorticoid exposure. While trauma and chronic stress are well documented to alter HPA-axis regulation, cortisol dynamics, and inflammatory burden over the lifespan, these associations do not establish direct causality for SAI. What this framework proposes is biological plausibility, not diagnostic certainty: long-term stress exposure may recalibrate stress signaling systems in ways that increase vulnerability, obscure early dysfunction, or interact with later clinical insults. This hypothesis underscores the need for longitudinal, pattern-based assessment rather than single-timepoint hormone measurements—especially in populations exposed to sustained early-life adversity.

Positive Deviant Closing: The Question Medicine Keeps Dodging

Medicine loves clean causes.
One lesion.
One lab.
One moment in time.
But bodies raised in chaos don’t fail cleanly.

If a child spends years learning that safety is temporary, that vigilance is survival, that rest is a liability — why are we surprised when their stress system grows quiet instead of loud? Not broken.
Adaptive. Efficient. Conserving. Invisible.
Until it isn’t.

This is not a claim that trauma “causes” adrenal insufficiency.
It’s a refusal to pretend that decades of physiological adaptation don’t matter once a patient walks into a clinic. It’s a challenge to a system that measures hormones without measuring history by asking the right questions, that diagnoses failure without asking what the body had to endure to keep functioning. I searched for the correct term to use here. At first, I wondered whether “diagnostic empathy” was the right term. It turns out it isn’t a formally established concept in medicine. Still, there are several existing frameworks that gesture toward what I’m describing, including diagnostic humility (acknowledging uncertainty and the limits of medical knowledge), contextualized diagnosis (interpreting symptoms within lived, social, and structural realities), and narrative medicine (integrating patient stories into clinical care).

I intentionally did not foreground the commonly used term “trauma-informed care.” While deeply valuable, lived experience has made me cautious of how easily it can slide into assumption — particularly the assumption that disclosed experiences must be unprocessed, pathogenic, or explanatory. Making room for diagnostic empathy means holding open a different possibility: that an incident or event may not have affected a patient in the expected way, cultural factors may impact a patients experience of an event, may already be integrated, or may manifest physiologically in ways that do not match familiar psychological narratives.

The uncomfortable possibility is this:
some bodies don’t suddenly fail in adulthood. They’ve been compensating since childhood — and medicine showed up late.


Thank you for reading this.
Please support me and this work:

Please Help Me Pay for Meds!

When a child in foster care is placed in a psychiatric or congregate facility not due to clinical need, but because no foster home is available we are not providing care; we are containing trauma in the name of convenience. These placements, increasingly common across the U.S., are often justified with clinical language yet yield measurable harm rather than healing.

Institutional settings typically deny youth the opportunity to acquire basic independent living skills. Children in these environments do not learn to shop, cook, manage money or schedules, or complete routine household tasks. Instead, meals arrive on rigid schedules, laundry is processed in bulk, and daily decisions are made by rotating staff leaving youth unprepared for the expectations of adult life (Acklin, 2023; Casey Family Programs, 2021). Without this practical training, many foster alumni struggle with housing, financial instability, and even involvement in the criminal legal system.

Beyond practical skills, institutionalization stunts social and emotional development. Youth are isolated from typical peer groups and community life experiences essential to building trust, managing conflict, and understanding social norms. The result: emotional detachment, fragile relationships, and difficulty functioning in educational or work environments (Nelson et al., 2014; Vince & Casey Family Programs, 2021).

A juvenile in congregate care may never form a consistent bond with an adult. High staff turnover and limited mentorship mean children often lack someone to guide them through crises, celebrate their milestones, or model healthy adult behavior. Without sustained adult relationships, youth frequently internalize distrust or expect only monitoring and control from authority figures (Casey Family Programs, 2021; qualitative interviews in Ohio; Kelly et al., 2024).

Missed rites of passage like learning to drive, attending school dances, holding a part-time job, or celebrating family and cultural traditions are common for institutionalized youth. These experiences anchor identity, build confidence, and contribute to a sense of belonging. Without them, many emerge into adulthood feeling unmoored.

Control and compliance dominate institutional cultures. Youth are taught to follow rules, ask for permission, and suppress autonomy. Mistakes are punished rather than treated as learning opportunities, and critical thinking is discouraged. This fosters learned helplessness a mindset at odds with adulthood, where initiative and self-advocacy are essential (institutional syndrome literature; institutional placement reports).

In such settings, educational and vocational support often lag. Individualized Education Programs (IEPs) legally binding documents that outline special education services for students with disabilities under the Individuals with Disabilities Education Act (IDEA) are frequently underdeveloped, ignored, or not followed at all. These programs are meant to provide tailored academic goals, support services (like speech or behavioral therapy), and accommodations to help youth succeed. Yet in institutions, they’re often just paperwork with no teeth. Vocational training is minimal. Resume-building and job search guidance are rare. Many youth age out without clarity on what they are good at, how to translate that into a career path, or how to apply for further education or work (Courtney & Dworsky, 2010; Acklin, 2023).

Compounding these systemic failures, youth often exit institutional care without critical personal documentation or bureaucratic literacy. Many leave without birth certificates, Social Security cards, or state IDs, and with no knowledge of how to apply for housing, healthcare, education, or financial aid available for foster alumni (formerly institutionalized youth interviews, Casey Family Programs).

Institutional care also erodes autonomy. Youth internalize the message that they have no control over their bodies or their futures. Compliance becomes survival, not growth. Over time, this internalized disempowerment undermines goal-setting, resilience, and self-reliance.

The impact is disproportionately severe for Black, Indigenous, immigrant, Muslim, and LGBTQIA+ youth, who are more likely to be separated from cultural anchors in institutional settings. Lacking affirming representation or culturally relevant care, these youth face identity erasure, internalized oppression, and lasting psychological harm.

Lastly, institutionalized youth experience heightened criminalization. Behaviours that would be managed at home moodiness, defiance often result in police involvement, labels like noncompliant, and juvenile justice referrals. Studies show that institutionalized youth are nearly 2.5 times more likely than peers in family foster care to enter the juvenile justice system (Casey Family Programs, 2021; Teen Vogue series on foster care to prison pipeline).

The bottom line:

Psychiatric beds are not stopgaps they are safes in disguise. They replace homes with routines, relationships with regulation, and potential with procedural compliance. They prepare youth not for adulthood, but for marginalization.

If we want different outcomes, we must build different systems: homes over institutions, trauma-informed support over supervision, autonomy over management. Until then, we’ll keep producing young adults who were managed, monitored, and marginalized but never prepared to live.

Please Buy Me a Book or a Beverage

_________________________________________________________________________

References

Acklin, T. (2023). Prolonged exposure to congregate care and foster youth outcomes. [Unpublished doctoral dissertation]. California State University, San Bernardino. (casey.org, teenvogue.com, scholarworks.lib.csusb.edu)

Casey Family Programs. (2021). Impacts of group placements. Retrieved from Casey Foundation resources. (casey.org)

Kelly, et al. (2024). Youth experiences in congregate care: Agency, relationships, and safety in care transitions. Child & Family Social Work. (link.springer.com)

Courtney, M. E., & Dworsky, A. (2010). Outcomes for youth aging out of foster care. Children and Youth Services Review. (pmc.ncbi.nlm.nih.gov)

Nelson, C. A., et al. (2014). The Bucharest Early Intervention Project: Early institutionalization effects on brain and behavior. The Lancet. (en.wikipedia.org)

Adopting a foster youth isn’t just about giving someone a home; it’s a full-throttle act of rebellion against the systems that leave kids behind. In a world that rewards maintaining the status quo, stepping up to adopt a foster youth is the ultimate punk rock ‘ counter culture move—it defies systemic apathy, dismantles inequity, and builds resilience in the face of generational cycles of neglect. Let’s talk about why this matters, why it’s critical, and why you, yes you, should do it.

A Broken System That Needs Us to Fight Back
The foster care system is, by design, a temporary holding cell for kids. What it is not designed to do is provide permanent, stable, loving homes. In 2023, more than 391,000 children were in foster care in the United States, and over 113,000 of them were waiting to be adopted. Many will age out without permanent families, leading to staggering rates of homelessness, unemployment, and mental health crises (Child Welfare Information Gateway, 2023). The system wasn’t built to empower; it was built to contain. Adopting a foster youth directly disrupts this cycle, offering stability, support, and love to a kid who has been let down too many times.

Dismantling Inequity, One Family at a Time
Foster youth are disproportionately from marginalized communities. For BIPOC youth, systemic racism compounds the challenges of foster care. According to The Annie E. Casey Foundation (2022), Black children make up 14% of the U.S. population but 23% of children in foster care. Adoption isn’t just an act of love—it’s an act of equity. By adopting, you’re taking a stand against systemic neglect, refusing to let a flawed system dictate the future of these children.

For Black children, systemic racism compounds the challenges of foster care. While the numbers tell us Black children make up a significant portion of the foster care population, yet there is a notable disparity in the number of Black adoptive parents. This imbalance often leads to transracial adoptions, which, while providing homes, may not fully address the cultural needs of Black children. By encouraging more Black families to adopt, we can work towards a more equitable system that respects and maintains cultural identities.

The EMBRACE Project by Kidsave, in collaboration with Gallup, seeks to uncover and reduce the gap between the number of older Black youth in foster care and the number of Black families mentoring, fostering, and adopting these children. This initiative highlights the importance of community involvement in creating equitable solutions within the foster care system.

Anti-Fragility: Building Resilience for the Future
Foster youth are the epitome of anti-fragility—they’ve endured, adapted, and survived circumstances many of us can’t imagine. When you adopt, you don’t just provide a home; you create a space where that simple act of surviving can evolve into thriving. Resilience research shows that stable, supportive relationships are the number one predictor of positive outcomes for children who have experienced trauma (National Scientific Council on the Developing Child, 2015). Your love and support become a literal lifeline.

Debunking the Myths
Let’s clear the air: adopting foster youth isn’t charity, and it isn’t a savior complex.
It’s about partnership. It’s about stepping into someone’s life and saying, “I’ve got your back.” Are there challenges? Sure. But the rewards—witnessing growth, sharing joy, and breaking cycles—are revolutionary.

The Positive Deviance Argument
Adoption is like counter-culture because it’s transformative.
It says, “I reject the narrative that these kids are someone else’s problem.” It takes hearts and minds that refuse to accept the bleak statistics. And it throws a wrench into the machinery of inequity and neglect. Foster youth don’t need pity; they need partners, allies, and parents who believe in their potential.

So, if you’re considering adoption, let me say this: You’re not just changing a life—you’re starting a quiet revolution. The system didn’t build itself, and it won’t dismantle itself either.

That’s up to us.

____________________________________________________________________
Works Cited

Child Welfare Information Gateway. (2023). Foster care statistics 2023. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. https://www.childwelfare.gov

Comparison of Black and White Adoptive Parents of Black Children. (2019). U.S. Census Bureau. Bureau, U. C. (2019, February 14). A Nationally Representative Comparison of Black and White Adoptive Parents of Black Children. Retrieved from January 24, 2025, from Census.gov website: https://www.census.gov/library/working-papers/2017/demo/SEHSD-WP2017-10.html?

National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen the foundations of resilience: Working paper 13. Center on the Developing Child at Harvard University. https://developingchild.harvard.edu

University of Nevada. (2022). Transracial Adoption: Statistics and Social Challenges | University of Nevada, Reno. Retrieved January 24, 2025, from University of Nevada, Reno website: https://onlinedegrees.unr.edu/blog/transracial-adoption-statistics/?

The Annie E. Casey Foundation. (2022). Foster care by the numbers: A data snapshot. https://www.aecf.org

The Dave Thomas Foundation for Adoption. (2024, October 15). Retrieved January 24, 2025, from Dave Thomas Foundation for Adoption website: https://www.davethomasfoundation.org/resource/kidsaves-embrace-project/?utm_source=chatgpt.com

This isn’t charity. It’s justice.

Abstract
Foster care alumni face significant health and socioeconomic disparities, yet Public health and other siloed academic disciplines (e.g., Social Work, Education, etc.) interventions remain fragmented and insufficient. This piece examines the systemic failures embedded in financial literacy, housing stability, education, food security, and healthcare access for young adults aging out of foster care. Drawing upon both lived experience and empirical data, this analysis highlights how existing public health frameworks fail to account for the compounded vulnerabilities of this hidden population. The social determinants of health (SDoH) approach is essential but insufficient without targeted, multi-faceted interventions that extend beyond traditional policy fixes. This paper calls for structural reforms, including mandated financial literacy education, guaranteed housing, flexible higher education policies, and universal food and healthcare access for foster care alumni. By shifting from problem description to solution design, public health institutions can address the root causes of these disparities rather than perpetuating cycles of neglect.

Keywords: foster care alumni, social determinants of health, financial literacy, housing instability, food insecurity, public health interventions

Introduction:
In the United States, transitioning into adulthood is daunting for most young people, but for those aging out of foster care, it is an exercise in survival. Unlike their peers in the general population, foster care alumni often lack financial safety nets, stable housing, and access to essential resources that many institutions assume are already in place. As a foster care alum (ages 3–17) and a public health scientist, I have lived this reality while analyzing the data that confirms what so many of us already know—public health institutions, higher education, and government agencies continue to fail this population.

This article builds upon my previous work, The Forgotten Fight: How Public Health Fails Foster Care Alumni and How Continued Neglect Fuels Lifelong Struggles (Best, 2024), by further unpacking the social determinants of health (SDoH) and exposing the systemic failures that perpetuate poor outcomes for this group. BIPOC females aged 14–18 who are preparing to age out of foster care in California, Texas, and Louisiana. These states were chosen due to their large foster care populations and high proportions of BIPOC youth (U.S. Department of Health and Human Services, 2022). The focus on BIPOC female, applies the upsteaming approach, by acknowledging the intersectional inequalities they face, including racial and gender-based disparities in mental health access and financial stability (Connelly et al., 2021). Public health must move beyond reactive, short-term solutions and toward structural, multi-faceted interventions that acknowledge the lived realities of foster care alumni.

The Social Determinants of Health: A Broken System for Foster Youth
The World Health Organization (WHO) defines the social determinants of health as “the non-medical factors that influence health outcomes,”including income, education, housing, and food security.” (WHO, 2023). While public health frameworks increasingly recognize the role of social determinants, interventions largely fail to account for the specific vulnerabilities of foster care alumni—one of the most at-risk hidden populations in the country. Institutions assume that young people aging out of care have received prior exposure to remedial interventions, despite the reality that most have aged out of fragmented systems that failed them at every turn.

Income Inequality and Financial Literacy Deficits
For most young adults, family networks serve as a crucial financial safety net. For foster care alumni, this safety net doesn’t exist. While only 7.4% of the general U.S. population under 25 earns less than $25,000 annually, a staggering 71% of foster care alumni fall below this threshold (AdoptionCouncil.org, 2024; Hood et al., 2022). Yet, financial literacy remains an afterthought in transition programs, leaving alumni ill-equipped to navigate credit management, debt, or emergency savings.

Financial literacy is a core component of various interventions for this population, yet the current curriculum does not adequately address the unique financial barriers that BIPOC females face, such as the racial wealth gap, discriminatory lending, and the impact of Social Determinants of Health (SDoH) on economic mobility (Shanks & Robinson, 2019). Studies show that BIPOC youth transitioning out of foster care are disproportionately affected by predatory financial practices, including subprime credit offers and banking deserts, which severely limit their ability to build financial stability (West et al., 2021).

I know this struggle firsthand. Even with a graduate education and a credit score higher than the national average, I have less than $20 in my bank accounts and zero savings. Like many others, I have skipped meals to avoid damaging my credit, recognizing that one missed bill can unravel years of effort. This is how the poor stay trapped in cycles of economic instability—by making impossible choices to preserve what little financial stability they have.

Housing Instability: A Manufactured Crisis
Stable housing is fundamental to health and economic mobility, yet for foster care alumni, it is a rare privilege. While 10.6% of the general U.S. population experiences housing instability, a staggering 76% of foster care alumni do, with 38% experiencing homelessness within the past year (Children’s Bureau, 2024; NFYI.org, 2017).

I have experienced this firsthand, from living with different friends in high school to living unhoused due to an unscrupulous landlord. Now, as a doctoral candidate, I reside in a converted garden shed—classified as an illegal domicile under municipal code. This situation isn’t unique. Many alumni live in similar undesirable housing arrangements, navigating a patchwork system that tolerates substandard conditions while failing to provide sustainable solutions.

Education: The Fantasy of Upward Mobility
Education is often touted as the great equalizer, yet foster care alumni are systematically excluded from its benefits. While 84% of the general population completes high school by age 19, only 56% of foster care alumni do (Lopez, 2019; Finally Family Homes, 2022). The disparities widen further in higher education: only 3% of alumni obtain a bachelor’s degree by age 25, compared to 26% of their peers (Lopez, 2019).

Post-secondary education is often framed as the primary tool for economic stability, but these discussions assume access to resources—something foster care alumni rarely have. Many of us have had to work full-time while attending school, sacrificing sleep, health, and academic performance just to stay afloat. During my undergraduate years, I juggled three part-time jobs while attending school full-time, often surviving on three to four hours of sleep per night. The cumulative health toll of this grind is rarely acknowledged in policy discussions about educational attainment.

Food Insecurity and Healthcare Access
For foster care alumni, food insecurity is not a temporary hardship—it is a chronic condition. While 22% of young adults aged 19–25 experience food insecurity in the general population, that number jumps to 81% for foster care alumni (Park et al., 2024). The impact is compounded by healthcare disparities, with alumni facing annual healthcare costs that are nearly double the national average ($14,372 compared to $7,082) (Nugent et al., 2020).

The combination of food insecurity and unaffordable health care creates a perfect storm for long-term health issues. I have worked in food service just to ensure I had access to at least one meal a day. I have also delayed necessary medical care because of out-of-pocket costs (ie. co-pays, etc.), a common reality for many foster care alumni who lack comprehensive healthcare coverage. The stress of navigating these systems alone is its own public health crisis—one that remains largely invisible to policymakers.

Rethinking Interventions: A Call for Multi-Faceted Solutions
Public health institutions must abandon their fragmented, one-size-fits-all approach and develop interventions that acknowledge the full scope of challenges faced by foster care alumni. This requires:

1. Financial Literacy as a Multidisciplinary Public Health Imperative – Mandating financial literacy education in all foster care transition programs, ensuring alumni understand credit, debt, and wealth-building strategies.

2. Guaranteed Housing for Foster Care Alumni – Expanding and enforcing housing assistance programs to prevent homelessness, with policies that reflect the realities of alumni’s financial precarity.

3. Flexible Higher Education Support – Restructuring financial aid policies to reflect alumni’s lack of family support, providing year-round housing, and removing bureaucratic barriers to tuition assistance.This should include valuable time-sensitive resources relevant to these students.Also, consideration of the number of mature students who return to graduate school, policies should not be limited to students aged 25 and younger.

4. Universal Food and Healthcare Access – Guaranteeing food assistance and healthcare coverage for foster care alumni until at least age 30, recognizing the prolonged financial instability they face.

Beyond Measuring the Problem
Year after year, studies confirm the systemic failures facing foster care alumni, yet little changes. Public health institutions continue to describe the problem without investing in scalable, long-term solutions. This cycle of neglect fuels a public health crisis that affects not just foster care alumni but society as a whole.

I have lived every statistic outlined here. Despite earning multiple degrees and accumulating nearly $300,000 in student loan debt, I still struggle to find stable employment, housing, and financial security. My experience is not an anomaly—it is the norm. The question is, how much longer will policymakers and institutions continue to ignore it?

Let’s stop describing the problem and start designing the solutions.

Recommended Intervention:

A Culturally Responsive, Collaborative Multi-Disciplinary, Multi-Faceted Public Health Program for Foster Care Alumni
No human health disparity can be resolved within a single discipline.
To address the systemic failures highlighted above, this intervention proposes a multi-tiered, multi-disciplinary, culturally responsive program designed to equip BIPOC female youth aging out of foster care with the necessary tools to achieve long-term stability and success. This program integrates financial literacy, mental health resilience, education and career readiness, and housing support within a trauma-informed, antifragility framework.

Core Program Components
1. Mandated Financial Literacy Education

• Comprehensive financial education covering credit building, debt management, savings, and investment strategies (Lusardi & Mitchell, 2014).

• Interactive workshops led by financial mentors with lived experience to increase engagement and relatability (Sherraden, Johnson, Guo, & Elliott, 2011).

2. Guaranteed Transitional Housing & Economic Support

• Secure, subsidized transitional housing through partnerships with local governments and nonprofits (Dworsky & Courtney, 2010).

• Basic Income Pilot Programs to provide financial stability as alumni transition into independent living (Brown & De Cao, 2020).

3. Flexible Higher Education and Workforce Development

• Tuition-free access to community colleges and vocational training with additional stipends for books, transportation, and childcare (Rios, 2020).

• Partnerships with local businesses to establish paid internships, apprenticeships, and mentorships tailored to individual career aspirations (Moses et al., 2021).

4. Universal Food & Healthcare Access

• Expansion of SNAP and Medicaid eligibility beyond age 26 for foster care alumni to prevent food insecurity and delayed healthcare (Dworsky, Napolitano, & Courtney, 2013).

• Mobile health clinics and telehealth services providing mental health care, reproductive health services, and trauma-informed therapy (Bruskas & Tessin, 2013).

5. Mental Health Resilience & Anti-Fragility Training

• Implementation of cognitive resilience training, emphasizing self-efficacy, adaptability, and stress management (Masten, 2014).

• Peer-led support groups and mentorship networks to foster a sense of community and belonging (Greeson & Thompson, 2017).
  
  

Implementation & Evaluation
This program should be implemented in California or Texas (higher SES states), and Louisiana (2nd poorest State in the country), targeting regions with high foster care populations and racial disparities. Effectiveness will be measured through longitudinal tracking of financial stability, employment rates, housing security, mental health metrics (a modified PHQ-9, GAD-7), and a modified self-reported resilience scale specific to this population (Connor-Davidson Resilience Scale) (Connor & Davidson, 2003).

By addressing financial, educational, and health inequities through a structural, rather than piecemeal approach, this intervention seeks to prevent long-term disparities rather than merely mitigating their consequences. Public health institutions must move beyond reactive models and instead invest in preventative, evidence-based, and culturally tailored strategies to ensure that foster care alumni are not set up to fail but empowered to thrive.


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Works Cited

AdoptionCouncil.org. (2024). The human, social, & economic cost of aging out of foster care. Retrieved from: https://adoptioncouncil.org

Best, Sunshine.. (2024, December 23). The Forgotten Fight: How Public Health Fails Foster Care Alumni and How Continued Neglect Fuels Lifelong Struggles. Retrieved February 20, 2025, from Substack.com website: https://livedexperience.substack.com/p/the-forgotten-fight-how-public-health

Brown, D., & Cao, E. D. (2020). Child Maltreatment, Unemployment, and Safety Nets. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3543987

Bruskas, D., & Tessin, D. H. (2013). Adverse childhood experiences and psychosocial well-being of women who were in foster care as children. The Permanente Journal, 17(3), 5–10. https://doi.org/10.7812/TPP/12-121

Children’s Bureau. (2024). Outreach toolkit: National Foster Care Month 2024. Retrieved from https://cwig-prod-prod-drupal-s3fs-us-east-1.s3.amazonaws.com/public/documents/fostercaremonth-outreach-toolkit.pdf

Connelly, D., Kekwaletswe, C., & Johnson, K. (2021). Intersectional inequities in mental health care for BIPOC women: A scoping review. Social Science & Medicine, 285, 114293. https://doi.org/10.1016/j.socscimed.2021.114293

Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113

Greeson, J. K. P., & Thompson, A. E. (2017). Aging out of foster care and the transition to adulthood: Past research, current knowledge, and future directions. Child and Adolescent Social Work Journal, 34(3), 211–221. https://doi.org/10.1007/s10560-016-0469-1

Dworsky, A., Napolitano, L., & Courtney, M. (2013). Homelessness during the transition from foster care to adulthood. American Journal of Public Health, 103(S2), S318-S323. https://doi.org/10.2105/AJPH.2013.301455

Hood, R. B., et al. (2022). Housing stability and healthcare access among women in Ohio. Maternal and Child Health Journal, 26(11), 2185–2191.

Lopez, K. (2019). Black Foster Youth Lives Matter. Retrieved February 20, 2025, from Naspa.org website: https://www.naspa.org/blog/black-foster-youth-lives-matter

Lusardi, A., & Mitchell, O. S. (2014). The economic importance of financial literacy: Theory and evidence. Journal of Economic Literature, 52(1), 5–44. https://doi.org/10.1257/jel.52.1.5

Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85(1), 6–20. https://doi.org/10.1111/cdev.12205

Moses, T., Paul, M., & Miller, A. (2021). Evaluating workforce development programs for foster youth: A case study of mentorship-based employment programs. Youth & Society, 53(2), 221–245. https://doi.org/10.1177/0044118X20929876

Nugent, C. N., et al. (2020). Demographics and healthcare characteristics of adults who have ever been in foster care: United States, 2011–2017. National Health Statistics Reports, 138.

Park, S. (Ethan), et al. (2024). Prevalence and predictors of food insecurity among transition-age foster youth. Journal of Public Child Welfare, 1–30.

Rios, V. M. (2020). Punished: Policing the lives of Black and Latino boys. NYU Press

Sherraden, M. S., Johnson, L., Guo, B., & Elliott, W. (2011). Financial capability in children: Effects of a financial education program. Journal of Consumer Affairs, 45(1), 70-94. https://doi.org/10.1111/j.1745-6606.2010.01196.x

Taleb, N. N. (2012). Antifragile: Things that gain from disorder. Random House.

U.S. Department of Health and Human Services. (2022). Foster care data. Administration for Children and Families. https://www.acf.hhs.gov

West, S., Finch, I., & Currie, J. (2021). Banking deserts, credit access, and economic mobility: Racial disparities in financial inclusion. Journal of Economic Perspectives, 35(2), 46-68. https://doi.org/10.1257/jep.35.2.46

In the United States, imagine facing adulthood with the odds stacked against you from the start. For youth aging out of foster care, the challenges they face post-emancipation are stark. I speak from experience—both as a foster care alum (ages 3-17) and as a public health scientist, I know the struggle and got the receipts.
As we dig deeper into the data, it becomes clear that their outcomes differ drastically from their peers in the general population. Remember: the numbers (quantitative) highlight issues, but the lived experience tells the story behind the numbers (qualitative).

This edition will lay the foundation for future articles, by highlighting how social determinants of health—like income, education, housing, and food security—play out for foster care alumni. Public health research and practice have historically fallen short in addressing the needs of this population. The numbers reveal both systemic failures and opportunities for targeted intervention. Year after year, public health institutions and government bodies fail to acknowledge that youth in foster care or those transitioning out of care as legal adults face significant disparities related to social determinants of health. Yet, this is a connection NO ONE seems to be talking about.

While Canada lists slightly different determinants that impact health than the U.S. Centers for Disease Control and Prevention, and the World Health Organization has its own framework, we’ll focus on the five overlapping social determinants—non-medical factors that impact human health—comparing the experiences of adults who transitioned out of foster care (as I have) with those of the general U.S. population. Fun fact: there are also Indigenous Social Determinants of Health, which are worth checking out for their integration of lived experience.

Income Inequality

While only 7.4% of the general population under 25 earns less than $25,000 annually, a staggering 71% of foster care alumni fall below this threshold (AdoptionCouncil.org, 2024; Hood et al., 2022). This economic disparity highlights the gaps in support systems for foster care youth. Without strong employment prospects or support networks, foster youth are at a significant disadvantage, often cycling through low-wage jobs that offer little opportunity for upward mobility. This cycle will continue without training in financial literacy. I struggled with it throughout my late adolescence and early adult years. Even now, as a mature student earning a graduate degree in hopes of improving my employment prospects, I struggle to make ends meet without any academic or family support to rely on in case something drastic happens. I became aware of the importance of maintaining good credit and have been careful to only have two credit cards, each with modestly low limits. Despite having over a quarter million dollars in student loans and less than $20 total in my bank accounts, I’m proud to say that, according to my credit management app, I’ve maintained a higher-than-average credit score. At this time, I have no savings. As I continue the challenge of finding employment—where I’m often told I’m overqualified, ghosted, or outright rejected—I’d rather continue skipping meals than risk damaging the credit score I’ve worked so hard to maintain. At this rate, I cannot save money without an income, so I doubt I’ll afford to attend my graduation and doctoral hooding ceremonies, let alone relocate to a state with more lucrative employment options. This is how and why the poor get stuck.

Housing Instability

Housing insecurity is another critical issue. Only 10.6% of the general population reports experiencing housing instability, compared to a shocking 76% of foster care alumni (NFYI.org, 2017; HHS.gov, 2008). Of this group, 38% have faced housing instability in just the past year (Children’s Bureau, 2024). Stable housing is foundational to building a secure life, yet foster youth are often left without this crucial safety net, making it difficult to pursue education or stable employment.

Personally, I lived with friends during high school for a year or two, but was asked to leave because they already had five kids, and the expense of another mouth became too much. I still love them today—Toronto winters are no joke, and without them, my options felt non-existent. Years later, while deciding to return to school after a decade in the private sector, I experienced life unhoused due to the illegal actions of a shady landlord. Now, I’m finishing my doctorate living in a 15 x 12-foot renovated garden shed. It has a toilet, sink, and shower stall, and looks like a freestanding storage room. None of the three small windows open, and there is no back door. After working a short-term state contract doing advocacy work addressing air quality for residents with hard-to-treat asthma, I learned, according to current municipal policy, that my unit doesn’t qualify as a legal domicile, though it was approved by city and federal agencies. I know several people in similar units—it’s what we can afford in a state where the minimum wage has been stagnant since 2009. I miss having a bathtub. Hot baths were my mental health haven and happy place.

Education Disparities

Educational attainment is often seen as a key predictor of future success, yet foster care alumni consistently lag behind. While 84% of the general population completes high school by age 19, only 56% of foster care alumni do the same (NASPA, 2019; Finally Family Homes, 2022). Many of my peers had to work to support themselves while in high school, and few schools offer resources tailored to the specific needs of this population.

The gap widens in higher education: only 3% of foster care alumni complete a bachelor’s degree by age 25, compared to 26% of their peers in the general population (NASPA, 2019). Less than 1% earn a master’s degree. It seems no one even bothers to measure how few earn doctorates. ChatGPT once told me it’s likely 0.0005%, based on the obstacles we face. This drastic difference underscores the need for educational interventions that support foster youth through high school and, when appropriate, beyond—whether through the non-academic S.T.A.R. path (Skilled Through Alternative Routes) or the college/university route. Post-secondary education is widely reported as the best tool for achieving economic stability, but these reports assume students are on the advantaged side of the Social determinants factors that improve and sustain health and wellness, making this pursuit feasible.

Food Insecurity & Health Costs

Food insecurity affects 22% of the general population aged 19-25, but for foster care alumni, this number skyrockets to 81% (Park et al., 2024). Coupled with healthcare costs that are double the average—$14,372 compared to $7,082 for the general population (Nugent et al., 2020)—these figures illustrate the compounded challenges foster care alumni face.

I couldn’t find specific data on disparities or discrimination faced by foster care alumni in healthcare environments. I’ll share my own experiences with stigma in medical and other settings in future articles. But without stable food access and affordable healthcare, achieving overall well-being remains out of reach for many. During my lean financial times, I worked in food service just to have access to at least one meal a day.

During my undergrad, I worked three part-time jobs, 5-6 days per week, in addition to full-time school, leaving me with only 3-4 hours of sleep a night. I couldn’t afford a car, and before I used a tax refund to buy a bike, walking 60-90 minutes one-way across the city was a regular occurrence. This constant strain added to my mental and physical exhaustion, especially when public transport was inefficient or unaffordable. Four years of sleep deprivation caused a domino effect of health issues—none of which anyone I knew could relate to.

Conclusion

As heartbreaking as it is to admit, there isn’t one statistic listed above from the social determinants of health that I haven’t experienced directly since leaving foster care. Despite earning a graduate education—a master’s degree with a partial CDC scholarship—and incurring nearly $300,000 in student loan debt, while depending on food pantries, I’m still struggling to find work at the time of this writing.

These disparities show the urgent need for systemic change, approached through multiple lenses. I have ideas.

Let’s keep this conversation going. Let’s not just continue to measure and describe the problems (academia does enough of that) — let’s brainstorm solutions.

PLEASE subscribe, share, and engage with this content to support me as I work towards developing interventions, supporting grassroots efforts, and pushing for policy changes that support foster care youth in their transition to adulthood. Future newsletters will vary, a few free, while others will only be available to paid subscribers. (It helps make the ends meet!)

In the next issue, we’ll explore innovative approaches and interventions that can close these gaps, ensuring a brighter future for all young people while creating healthier adults.

See you in the new year - Stay safe and Be Kind!
a passionate, positive deviant

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Works Cited:

AdoptionCouncil. Org ( 2024). The Human, Social, & Economic Cost of Aging Out of Foster Care. Retrieved September 6, 2024, from National Council For Adoption website: https://adoptioncouncil.org/publications/the-human-social-and-economic-cost-of-aging-out-of-foster-care/

AECF.(2023). FOSTERING YOUTH TRANSITIONS 2023 STATE AND NATIONAL DATA TO DRIVE FOSTER CARE ADVOCACY ACKNOWLEDGMENTS. Retrieved from https://assets.aecf.org/m/resourcedoc/aecf-fosteringyouth-executivesummary-2023.pdf

Children’s Bureau.(2024).Outreach Toolkit National Foster Care Month 2024.. Retrieved from https://cwig-prod-prod-drupal-s3fs-us-east-1.s3.amazonaws.com/public/documents/fostercaremonth-outreach-toolkit.pdf?VersionId=gFGzuX.lJKdNA0_sE8bjIob2ZTmLaJ5o

Finally Family Homes.(2022).42 Aging Out of Foster Care Statistics.Retrieved September 6, 2024, from Finally Family Homes website: https://finallyfamilyhomes.org/the-problem/

HHS.gov. (2008).“Half of all foster youth who age out of the system are able to find a job that can support them. Those who do find employment tend not to earn much money.”
Coming of Age: Employment Outcomes for Youth Who Age Out of Foster Care Through Their Middle Twenties Office of the Assistant Secretary for Planning and Evaluation. Retrieved from https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//42726/report.pdf

Hood, R. B., Turner, A. N., Smith, M., Chakraborty, P., Chettri, S., Bessett, D., Norris, A. H., & Gallo, M. F. (2022). Housing Stability and Access to General Healthcare and Reproductive Healthcare Among Women in Ohio. Maternal and child health journal, 26(11), 2185–2191. https://doi.org/10.1007/s10995-022-03492-5

NASPA. (2019). Black Foster Youth Lives Matter. NASPA, Student Affairs Administrators in Higher Education.Retrieved September 6, 2024, from Naspa.org website: https://www.naspa.org/blog/black-foster-youth-lives-matter

NFYI. org. (2017, May 26). 51 Useful Aging Out of Foster Care Statistics | Social Race Media - NFYI. Retrieved August 26, 2024, from NFYI - National Foster Youth Institute website: https://nfyi.org/51-useful-aging-out-of-foster-care-statistics-social-race-media/

Nugent C.N., Ugwu C., Jones .J, Newburg-Rinn S., & White T. (2020). Demographic, health care, and fertility-related characteristics of adults aged 18–44 who have ever been in foster care: United States, 2011–2017. National Health Statistics Reports; no 138. Hyattsville, MD: National Center for Health Statistics.

Park, S. (Ethan), Nadon, M., Okpych, N. J., Harty, J. S., & Courtney, M. (2024). Examining prevalence and predictors of food insecurity for transition-age youth transitioning out of foster care. Journal of Public Child Welfare, 1–30. https://doi.org/10.1080/15548732.2024.2332611

Less than 1% of foster care alumni achieve a Master’s degree, and an even smaller number reach the Doctorate level. As a Black woman, 15 months away from my Doctorate in Public Health, my journey has been anything but typical. With roots in foster care, IT, and global experiences as a chef, I’ve defied odds to enter Public Health leadership. In this piece, I share the pivotal moments that shaped my path and why more foster care alumni should enter Public Health to drive research and policy change.

🧠 Lessons in Resilience: Navigating Challenges and Advocating for Change

Foster care alumni, especially Black women like myself, face significant academic and social hurdles, from financial instability to feelings of isolation in predominantly white institutions. Throughout my journey, from periods of homelessness to juggling multiple jobs while studying, I’ve drawn on resilience and the power of lived experience. In working with Kidsave’s EMBRACE initiative, I apply my unique insights to advocate for systemic changes in foster care and public health, with a focus on the mental health impacts of intersectionality.

🌍 A Call for Support: Empowering Foster Youth Through Representation

Foster youth have unique strengths, shaped by their lived experiences. However, they often lack the mentorship and community support needed to realize their potential. I believe in the power of representation—showing Black foster youth that they can thrive and succeed in spaces traditionally closed to them. Through my work with EMBRACE, I aim to bring more foster care alumni into leadership positions and provide the support that I didn’t have but deeply needed. Read my full story on how we can uplift foster care youth and reform the system for a better future.

Read more here: Shining Through Adversity

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