Project Summary/Abstract
The COVID-19 pandemic has been a major test of the health care delivery system, disrupting primary and
mental health care to vulnerable children and threatening the financial stability of providers. In doing so, the
pandemic created an opportunity to examine where the delivery system is robust and where improvements and
alternative policy approaches should be considered. For children with pre-existing vulnerabilities these
disruptions, in the face of increased risks from social isolation and economic stressors, are particularly
concerning. How health systems recover and respond to the needs of the most vulnerable speaks to the
structure of safety net systems and the policies that support them. The proposed study examines multiple
vulnerable and at-risk child populations in safety net systems – children with emotional disorders, children who
experienced prior abuse, children in foster care, homeless children, children who identify as LGBTQ+, and
those who are make Black, Indigenous and people of color (BIPOC).
The proposed study uses electronic health record data from the ADVANCE clinical data research network
which represents more than 500,000 children treated annually at safety net, community health centers. This
unique clinic network cares for largely uninsured and publicly insured children in 30 states. In addition, the
study also uses Medicaid data in 3 of the largest study states to examine additional primary and mental health
care outcomes. The aims of the study are to examine changes in primary and mental health care to vulnerable
children through the pandemic, transition and recovery periods, to examine health inequities in care over time,
and to uncover clinic, community, and payment policy drivers in safety net performance, in order to inform a
multi-pronged, corrective policy response to redress gaps.
