The Medicaid Engineer: Alex Briscoe on Reimagining Youth Mental Health
In conversation with Alex Briscoe
Alex Briscoe stands at the forefront of youth mental health care, drawing on over two decades of experience across alternative education, public schools, foster care, and mental health systems. As a former therapist, system leader, and innovative Medicaid engineer, Briscoe has consistently challenged traditional approaches to mental health treatment. His methodology, anchored in grassroots experience and data-driven analysis, combines practical insights from working directly with at-risk youth with sophisticated policy reform initiatives.
Q: What inspired you to create the children's trust, and how your journey shaped your approach to mental health reform?
A: My journey began in my early 20s when I worked at an alternative high school program for young people who had dropped out of traditional education. We created a unique model combining education with practical skills - our students would work on renovating houses for homeless families while completing their high school education.
I was only a few years older than most in the program. I tell this story because I was amazed at how awesome young people are. Every one of the 300 young people in our program had faced significant challenges, but they were determined to live a positive life.
After serving as a therapist in Oakland high schools, where traditional training often missed the mark, I went on to work across the full spectrum of youth mental health - from children's hospitals and foster care to juvenile detention and crisis response - before ultimately leading a large public healthcare system.
When I left public service in 2016 and 2017, a group of foundations invited me to discuss it. In preparation for that talk, I started looking at data on admission rates for self-injury in 2017. The data was overwhelming. We discovered this doubling, 104% increase in inpatient admissions—that's got to be the single largest increase in emergency department utilization ever.
A group of philanthropists asked me what I wanted to do and what the solution was. I knew we had to fix Medicaid because that covers half the kids. We received a small grant to lead an effort to change the way we support children's social and emotional health and it allowed us to hire great people. We did a lot of listening and learning our first two years.
I've been deeply committed to the health and welfare of young people my entire life and I believe that young people are awesome and that the current medical model of mental health hasn't served them well. It's a uniquely difficult time to be young.
Q: How do you approach collaborating with different stakeholders—policymakers, funders, community organizations, and all stakeholders in the mental health space—and how do you work to align incentives?
A: The question of the social and mental health of young people has so many different components that you have to build a broad tent. Almost everybody has to see themselves in the solution for it to be relevant. What makes youth mental health such an important topic right now for our culture is it impacts everybody. If you ever were a kid or you know a kid, you know it's a uniquely difficult time to be young.
It doesn't matter what your politics are, the harsh reality of emergency room utilization and 911 calls - that's just a hard fact. We can just look at the epidemiology of what's going on in young people's lives and know that real things are happening. Our strategy is to go out and name the problem with real data and rigorous inquiry, but then equally rigorous listening.
Q: What do you wish more entrepreneurs, investors, and people in the startup ecosystem would understand and know about Medicaid policy and its potential to drive systemic change?
A: It's where the money is. Whenever an entrepreneur says to me, "I'm working in the commercial market and once I get that figured out, I'm going to go to Medicaid," I'm like? Medicaid and CHIP are half of all children. The children with the greatest needs are in Medicaid and the CHIP system involves kids.
One of the few places in the entire American healthcare system where Medicaid pays better is behavioral health. Under EPSDT, there are unique federal protections for children's mental health. I want entrepreneurs to understand the history and architecture of Medicaid and how it can be leveraged for creative solutions.
Q: What do you think about the sentiment right now, especially in schools regarding phone bans, social media is bad, and that's the solution to the mental health crisis.
A: You just shouldn't take your phone out in class. A mentor of mine once said, "Adolescents will be more sophisticated at manipulating authority than you could ever be at wielding it, so don't even try." This game of cat and mouse of denial and restriction - there are reasonable limits adults should set for children, but they get increasingly difficult to enforce, particularly in high school age.
I'm more interested in teaching young people how to interpret and manage their access than I am in denying them access. I'm more interested in asking young people how they handle it. When you see somebody's airbrushed body for the 10th time and it doesn't look like yours - how do you and your friends talk about that? You realize that 14 skin brand companies sponsor the person who's sending you that picture and they're trying to sell you something.
I'm more interested in developing critical resources in acts of resistance than in denial or restriction. What, they can't have it at school, so then they can from 4 PM to 7 AM? I'm not saying six-year-olds should have unfettered access to Snapchat. Parents should make their own decisions about that. I really respect parents who do have some limits.
Q: What are the key opportunities that you see in 2025 or just the next five years for everyone in the mental health ecosystem to focus on? What do you think is the next frontier?
A: In the entrepreneurship space, I'm really interested in the near-peer stuff. This connectivity between young people at near peer status - you can tell a 14-year-old anything, but a 24-year-old who looks like them, they'll hang on every word.
There's something about pro-social community building that the entrepreneurship sector has stumbled on and that the technology space is uniquely situated to facilitate. There's a social movement among young people to understand and resist these practices, and the impacts of these practices in their lives.
We focus so much on where young people are making poor decisions, and we miss this whole world of young people who are making excellent decisions. Let's mine their experience and decision-making process and use it to support young people who may be getting sucked in.
Q: What's next?
A: A passion project of mine just got a lot of money. While working in Nevada County, I began a project that trained young people in detention and coming out of foster care to be EMTs and work in emergency medical services. We got everything possibly wrong and we persisted. Over 12 years in three locations, we trained 600 young people and are now opening 14 new sites nationwide. It's called EMS Core.
I will be working on that type of project, blending workforce development, healing, and adversity. I'll also be doing a lot of Medicaid systems change work in other states and some projects in California that came out of the trust.
Find Briscoe’s LinkedIn here: https://www.linkedin.com/in/alexbriscoe/
Find the California Children’s Trust here: https://cachildrenstrust.org/