Impact of the COVID-19 Pandemic on Safety Net Performance, Disparities, and Vulnerable Children

项目摘要/摘要 新冠肺炎大流行一直是对医疗保健提供系统的重大考验，扰乱了主要和 向弱势儿童提供心理健康护理，并威胁提供者的财务稳定。在这样做的时候， 大流行创造了一个机会来检查交付系统在哪里是强大的，在哪里改进和 应考虑其他政策方法。对于有先前存在的脆弱性的儿童，这些 面对来自社会孤立和经济压力的风险增加，破坏尤其严重。 关于。卫生系统如何恢复和响应最弱势群体的需求 安全网系统的结构和支持它们的政策。这项拟议的研究考察了多个 安全网系统中的弱势和高危儿童群体--患有情绪障碍的儿童、 经历过虐待、寄养儿童、无家可归儿童、自认为LGBTQ的儿童，以及 那些制造黑人、土著和有色人种的人(BIPOC)。 这项拟议的研究使用了来自高级临床数据研究网络的电子健康记录数据 这代表着每年有50多万儿童在安全网和社区卫生中心接受治疗。这 独特的诊所网络照顾30个州的大部分未参保和公共参保的儿童。此外， 这项研究还使用了三个最大的研究州的医疗补助数据来检查额外的初级健康和精神健康 护理结果。这项研究的目的是检查对弱势群体的初级和精神卫生保健方面的变化 通过大流行、过渡期和恢复期的儿童，以审查随着时间的推移保健方面的不平等现象， 并发现诊所、社区和支付政策驱动因素在安全网中的表现，以便向 多管齐下，纠正差距的政策回应。

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.