Browsing by Author "Van Stekelenburg, Brianna"

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Open Access
Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina's Healthy Opportunities Pilots Program.
(Health affairs (Project Hope), 2024-02) Huber, Katie; Nohria, Raman; Nandagiri, Vibhav; Whitaker, Rebecca; Tchuisseu, Yolande Pokam; Pylypiw, Nicholas; Dennison, Meaghan; Van Stekelenburg, Brianna; Van Vleet, Amanda; Perez, Maria Ramirez; Morreale, Madlyn C; Thoumi, Andrea; Lyn, Michelle; Saunders, Robert S; Bleser, William K
North Carolina Medicaid's Healthy Opportunities Pilots program is the country's first comprehensive program to evaluate the impact of paying community-based organizations to provide eligible Medicaid enrollees with an array of evidence-based services to address four domains of health-related social needs, one of which is housing. Using a mixed-methods approach, we mapped the distribution of severe housing problems and then examined the design and implementation of Healthy Opportunities Pilots housing services in the three program regions. Four cross-cutting implementation and policy themes emerged: accounting for variation in housing resources and needs to address housing insecurity, defining and pricing housing services in Medicaid, engaging diverse stakeholders across sectors to facilitate successful implementation, and developing sustainable financial models for delivery. The lessons learned and actionable insights can help inform the efforts of stakeholders elsewhere, particularly other state Medicaid programs, to design and implement cross-sectoral programs that address housing-related social needs by leveraging multiple policy-based resources. These lessons can also be useful for federal policy makers developing guidance on addressing housing-related needs in Medicaid.
Open Access
Assessing and Addressing Protection Needs of Undocumented Migrant Children in North Carolina
(2015-05-06) Van Stekelenburg, Brianna
This thesis investigates differential protection outcomes among undocumented migrant youth from Central America who are transferred to North Carolina. The literature shows there is a significant gap in research on the protection needs of undocumented minors in the US, but also points to potential problems in child protection as migrant children are situated squarely within often competing agendas of human rights and national security imperatives. Lastly, research shows that children are dependent on states for basic services, yet lack of documentation and family support are shown to impede their access to basic services. In order to understand uneven protection outcomes among undocumented migrant youth in the US, I examine the following three interrelated questions: What happens when the children arrive in the US? How do they arrive in North Carolina? Why do some children end up in foster families, whereas others are reunited with their own families, others in institutions, and others deported? And, what are the protection needs of undocumented youth in North Carolina and the guardians who support them? Drawing on data collected from archival analyses of newspaper articles, focus group research, and semi-structured interviews with foster families, immigration lawyers, and agencies involved in the process in North Carolina, this research makes several key interventions in current debates about child protection, migration, and citizenship in North Carolina and in the US more generally. In examining how children end up in disparate circumstances, this mixed-methods research revealed that North Carolina lacks a clear policy on the issue, there is a spread of misinformation that exacerbates tensions around immigration and protection and there is a lack of support systems in place for child migrants and their families, as well as the particular professions (teachers, lawyers, and clinicians) that serve this population. Ultimately, this research reveals that state and federal governments are failing to protect the fundamental human rights of all children within the territory of the US, due to incoherent protection policy guidelines at different levels of government, and due to problems in uneven, contingent, and highly variable circumstances of policy implementation.