What if the system built to protect children is also the one traumatizing them?

Nicole Six — VP of Product Development at Sentara Health and a licensed clinical social worker — has spent her career inside the child welfare and behavioral health systems. From her early days as a social worker in New York City to leading large-scale Medicaid and child welfare initiatives in North Carolina, Nicole has seen how policy, poverty, and broken systems collide to shape the lives of vulnerable kids.

In this powerful conversation, she and Patrick Gilligan dive into what’s working, what’s failing, and what needs to change — now.

You’ll hear:

– Why children in foster care lose connection to their families and communities the longer they’re in care

– The painful truth that “we created the trauma” for many of the kids our systems claim to protect

– Why the best clinicians are leaving behavioral health — and how that’s quietly deepening the access crisis

– The case for upstream prevention and family-centered care

– What a transformed child welfare system could look like by 2030

– And the one thing Nicole says every child needs most: someone who loves them.

This episode is raw, eye-opening, and deeply human.

If you care about child welfare, mental health, or Medicaid reform — you need to hear this one.

Timestamps

00:00 – Introduction

02:00 – Nicole’s path from social work to leadership

07:00 – Lessons from child welfare in NYC vs. North Carolina

13:00 – Why prevention is everything — and why it’s underfunded

17:00 – The myth of “bad families” and what kids really need

24:00 – The mental health access crisis and why clinicians are leaving

30:00 – How to design systems that actually help families

36:00 – What a trauma-informed future could look like

40:00 – Why kids in care lose their connection to “their people”

43:00 – The hard truth: we created the trauma we’re trying to fix

48:00 – The one thing Nicole wishes every child could have