# Examining the impact of healthcare systems changes on healthcare use and health outcomes for children in foster care

> **NIH AHRQ R01** · CINCINNATI CHILDRENS HOSP MED CTR · 2024 · $399,999

## Abstract

Project Summary
Children exposed to poverty experience poorer health compared to their peers; for children in foster care,
these risks are compounded by maltreatment and out-of-home placement, resulting in even worse physical
and behavioral health outcomes. Variation in healthcare use and health outcomes for foster youth is the result
of the child welfare system, the caregiver, the individual child’s characteristics, and the healthcare system.
Unfortunately, communication across healthcare and child welfare systems is disjointed, compounding health
risk and increasing reactive and emergent healthcare use. The goals of this study are to evaluate the impact of
healthcare delivery models on health outcomes for foster youth and understand factors associated with
variation in healthcare use and health outcomes among children in foster care. To provide a holistic view of
children’s functioning, this study leverages 12 years of linked child welfare and EHR data (N ~ 9,600 patients)
in combination with Medicaid claims data and caregiver and self-reported health status for a subset of youth (N
= 200) to accomplish three aims: 1) Evaluate models of healthcare delivery on healthcare use and health
outcomes among foster youth as a result of: a) mandated visits alone; b) primary care, mandated visits, and
specialty care delivered within the same healthcare system; and c) coordinated information sharing between
healthcare and child welfare systems. 2) Identify causes of variation in healthcare use and health outcomes
related to child welfare system (e.g., foster care status) and caregiver characteristics (e.g., perceptions of
healthcare). 3) Understand how child characteristics (e.g., diagnoses, health risk behaviors, age, gender, race
and ethnicity) contribute to variation in healthcare use and health outcomes over time. This is the most
comprehensive examination of drivers of healthcare use and health outcomes among foster youth to date.
Mechanisms identified through this grant that account for the most variation in health outcomes will be targeted
in future studies evaluating how to modify healthcare delivery practices and collaboration across healthcare
and child welfare systems to improve health outcomes for foster youth. By examining healthcare use and
health outcomes, we will be better positioned to articulate where healthcare systems interventions parlay to
better health outcomes.

## Key facts

- **NIH application ID:** 10885022
- **Project number:** 5R01HS028589-03
- **Recipient organization:** CINCINNATI CHILDRENS HOSP MED CTR
- **Principal Investigator:** Sarah Beal
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $399,999
- **Award type:** 5
- **Project period:** 2022-09-30 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10885022

## Citation

> US National Institutes of Health, RePORTER application 10885022, Examining the impact of healthcare systems changes on healthcare use and health outcomes for children in foster care (5R01HS028589-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10885022. Licensed CC0.

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