Of 41.8 million American minors in 35 participating states, 39.4% of high-school students report two weeks or more of persistent sadness or hopelessness in the past 12 months. That is 2.4× the adult companion paper's pop-weighted frequent-distress rate (16.8%). The state-to-state range in youth-serving mental-health provider density is approximately 85× — three times wider than the comparable adult range. The youth access conversation is a state policy choice.
| Metric | Value |
|---|---|
| Participating states | 35 |
| Under-18 covered | 41.8M |
| Pop-weighted prevalence (sad/hopeless 2+ wks past 12mo) | 39.4% |
| Adult companion (frequent mental distress) | 16.8% |
| Youth-to-adult ratio | ~2.4× |
| Youth-serving provider density range (CT 500 vs PR 5.8 per 100K) | ~85× |
| Positive outliers (gap worse than uninsured predicts) | PR (+2.39σ) · NC (+1.81) · NJ (+1.53) |
| Negative outliers (gap better than predicted) | VT (-1.70σ) · AK (-1.69) |
Three animated state chloropleths render the analysis end-to-end. Each is a single-take exploration of one dimension of the state-level dataset.
Vermont: lowest youth-distress prevalence in the dataset (29.3%). University of Vermont Medical Center pediatric behavioral-health + state Medicaid expansion + Designated Agency system that mandates community-mental-health capacity. 1,059 youth-serving providers per 100,000 under-18.
Alaska: high distress (43.2%) but high access (1,085 per 100K). Indian Health Service + Alaska Native tribal health organizations + Title V MCH block grants for tribal communities. The federally-employed structural supply Alaska's negative-outlier status depends on.
Both are policy-driven, not market-driven.
Puerto Rico: gap +2.39σ worse than uninsured rate predicts — the strongest signal in the dataset. Youth-serving provider density 5.8 per 100,000 under-18 — by far the lowest. Post-Hurricane Maria workforce migration + federal Medicaid payment cap policy.
North Carolina: gap +1.81σ. Strong adult workforce, thin youth-serving subset. CCBHC implementation is the most likely policy lever.
New Jersey: gap +1.53σ. Among the most insurance-saturated states but the youth-serving workforce has lagged behind the adult-serving capacity.
State-level need from CDC YRBSS 2023 (high-school students grades 9-12 reporting persistent sadness/hopelessness 2+ weeks past 12 months, Total demographic). State-level provider supply from CMS NPPES (May 2026) filtered to 8 youth-serving mental-health taxonomies. Under-18 population from ACS 1-year 2023 (B09001). Uninsured rate under-19 from ACS 1-year 2023 (S2701). Gap ratio = (need × 1000) / state-supply per 100K. National OLS residual regression (state-level adaptation; within-state OLS at tract-level in adult companion). Z-score classification at ±1.5σ. Population-weighted dartboard sampling stratified by residual class. Framework atlas.need_vs_access_framework_v1 v1.1.0, reproducibility package below.
Twenty-seven canonical parts. Same spec as the adult companion paper. Status as of this build:
The Need-vs-Access Framework v1.1.0 is the second-iteration version of the analytical pipeline that produced the adult companion paper. The state-geography adaptation required a single new parameter (regression_grouping) — switching from within-state OLS (default for tract/county) to single national OLS (default for state). All other code is unchanged.
This is the framework's second published application. Eleven other access domains are queued.
| Stage | Status |
|---|---|
| Analysis complete | ✓ shipped |
| Working paper drafted | ✓ v1.0 draft |
| Framework v1.1.0 | ✓ active |
| Dataset published to MinIO | ✓ live |
| 14 text artifacts + 14 sub-pages | ✓ live |
| Animated visualizations | rendering |
| Trellison methodology rating | pending review |
| LedgerWell evidence-chain certificate | pending |
| DOI registration for dataset | pending |
| Public release | after Trellison + LedgerWell sign-off |