System and Social Determinants of the Health of Foster Children

项目摘要 拟议的研究将调查寄养的影响，以及寄养中的具体经验， 遭受虐待或忽视的儿童的身心健康。这群人是世界上 在美国很脆弱，不良健康和福祉结果的发生率高得不成比例， 在整个生命过程中。这项建议的目的是：（1）研究寄养对健康的影响， （2）调查寄养经历对寄养儿童在离开期间和离开后健康的影响 （3）评估寄养期间维持家庭关系对寄养儿童健康的影响 在离开寄养家庭后这一领域的先前研究受到一个或多个重大限制， 包括：对因果推理的威胁;横截面，短期或离散的观察期;小或 非代表性的样本;依赖于所有人报告的健康结果;以及缺乏对身体健康的关注。 健康本提案旨在解决这些局限性，并提供可靠的经验证据，说明 寄养对儿童的短期和长期健康的影响。 在目标1中，我们关注寄养如何随着时间的推移影响儿童的身心健康结果， 与参与儿童保护系统但仍留在家中的儿童相比，这一比例更高。使用 联系医疗补助和儿童保护记录，我们将观察之前，期间和之后的重大健康事件 寄养使用旨在改进因果推理的方法，我们不仅能够识别 我们不仅要了解寄养对健康的影响，还要了解这些影响是暂时的还是持续的。 在目标2和目标3中，我们关注寄养家庭中的儿童的经历，这些经历产生了异质性， 健康成果。最大限度地发挥我们的研究结果的潜力，为改善寄养儿童的健康状况提供信息 和福祉，我们强调寄养经验，是联邦和州改革的当前优先事项， 包括放置设置（例如，与亲戚，在集体之家），安置稳定性，与兄弟姐妹的安置， 以及父母和兄弟姐妹的探视权再次利用医疗补助和儿童保护记录，重点是 因果推理，我们将提供令人信服的证据，是否寄养的当前优先事项， 该系统有助于增进儿童健康。这些证据对于有效分配稀缺资源至关重要。 资源

Project Summary The proposed study will investigate the impact of foster care, and specific experiences within foster care, on the physical and mental health of children exposed to abuse or neglect. This population is among the most vulnerable in the U.S., with a disproportionately high prevalence of adverse health and wellbeing outcomes throughout the life course. The Aims of this proposal are: (1) Examine the effects of foster care on health over time; (2) Investigate the influence of placement experiences on foster children's health during and after exiting foster care; and (3) Evaluate the effects of maintaining family connections on foster children's health during and after exiting foster care. Prior research in this area has suffered one or more significant limitations, including: threats to causal inference; cross-sectional, short-term, or discrete observation periods; small or non-representative samples; reliance on caregiver-reported health outcomes; and a lack of focus on physical health. This proposal seeks to address these limitations and provide sound empirical evidence on the role of foster care in children's immediate and longer-tem health. In Aim 1, we focus on how foster care impacts children's physical and mental health outcomes over time, as compared with children involved with the child protection system but who remain in their familial homes. Using linked Medicaid and child protection records, we will observe significant health events before, during, and after foster care. Using methods intended to improve causal inference, we will be able to not only identify the impacts of foster care on health, but also understand whether those impacts are temporary or sustained. In Aims 2 and 3, we focus on the experiences of children within foster care that produce heterogeneity in health outcomes. To maximize the potential of our findings to inform efforts to improve foster children's health and wellbeing, we emphasize foster care experiences that are current priorities of federal and state reforms, including placement setting (e.g., with relatives, in group homes), placement stability, placement with siblings, and parent and sibling visitation. Again leveraging Medicaid and child protection records, and with a focus on causal inference, we will provide compelling evidence on whether the current priorities of the foster care system serve to enhance children's health. Such evidence is essential to the effective allocation of scarce resources.