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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.).