Project Summary
Youth in foster care have higher healthcare utilization and costs than the general population. Healthcare
systems, state departments of Medicaid, and other organizations often shoulder this high cost without evidence
of improved health outcomes for youth in foster care. Black youth in foster care are overrepresented within the
healthcare system. Black youth in foster care have unique needs within the healthcare system such as being
less likely to use preventative health care and significantly more emergency and urgent healthcare services
than White youth. However, the mechanisms that contribute to this racial disparity are currently unknown. This
study expands on Andersen’s theory of health service use by applying the framework of intersectionality
(understanding the influence of multiple social identities) to identify salient factors that interact with race to
influence healthcare use and wellbeing outcomes for youth in foster care. The goals of this study are to
understand variation in healthcare use for Black youth in foster care and identify the role that coordinated
medical care homes play in youth having better health when compared to youth who receive services from
multiple systems. This study utilizes 11 years of linked child welfare and electronic health records data
(N~7,500 patients) and incorporates the voices of young people in foster care through the use of a Research
Participant Advisory Council to accomplish two aims: 1) Determine the mechanisms that contribute to variation
in healthcare use for Black youth in foster care through the examination of child characteristics (i.e., gender,
age, mental health diagnoses, health behavior) and child welfare system level characteristics (i.e., number of
placement changes, placement type, number of youth in the same placement). 2) Identify how healthcare and
social service systems factors contribute to variation in healthcare use and health outcomes for Black youth,
such that coordinated medical care within the same system (i.e., primary and specialty care from one system)
will reduce the number of unscheduled health care days and result in better health outcomes (e.g., complete
vaccination records, healthy weight, stable mental health, lower health risk behaviors) when compared to youth
who receive services across multiple systems. Findings from this study may provide direction for intervention
targets to address inequality within the healthcare system related to coordination of care and healthcare
outcomes to improve health and promote equity for Black youth in foster care. Findings may also lead to
reducing the overall cost of healthcare among foster youth as well.
