Angelique Day

An interdisciplinary research team from the Wayne State University (WSU) School of Social Work and Western Michigan University (WMU) will use a $75,000 grant from Blue Cross Blue Shield of Michigan Foundation to determine whether Michigan's foster youth are receiving adequate preventive, dental and prenatal health care services. As many as 95% of foster care youth have at least one physical health condition and more than 50% experience two or more, due in large part to childhood abuse and neglect. Access to health care services is critically important to this population to improve health outcomes, which contribute to improved educational and social outcomes and prevent problems in later life.

The project will be led by Angelique Day, WSU assistant professor, national foster care expert, and director of Wayne State University's Transition to Independence Program for foster youth support. Day will collaborate with WMU epidemiologist and professor Amy Curtis, associate professor of statistics Rajib Paul, associate professor for geography Kathleen Baker, and graduate students from both universities to analyze Medicaid and foster youth casework data in order to track county-by-county utilization.

The longitudinal cohort study builds upon WSU-funded research conducted last year by Day and Curtis to gauge adherence to a requirement - imposed in 2010 when Michigan converted most foster youth health care administration from a fee-for-service model to a managed care system - that youth entering the system have a well visit within 30 days. This interdisciplinary expansion of that work, funded by Blue Cross Blue Shield of Michigan Foundation's Investigator Initiated Research Program, will examine data before, during and after that conversion (2009 through 2012) to determine whether foster youth ages 14-21 are receiving annual well visits, examine the frequency of foster youth dental visits and the nature of dental diagnoses, and assess receipt of prenatal care among pregnant foster youth. One in three females in Michigan's foster care system is pregnant at least once before the age of 18.

According to Day and Curtis, who is the director of WMU's Health Data Research, Analysis and Mapping Center (HDReAM), the 12-month study is innovative for several reasons. First, its interdisciplinary design employs a range of perspectives to capture how health care utilization varies not only within the foster youth population as a whole, but also in different geographic regions throughout the state. Second, it integrates two statewide databases, Michigan Department of Human Services foster youth case files and Michigan Department of Community Health Medicaid claims, that traditionally have been analyzed separately. Used together, these data sets have the potential to yield large amounts of information in a way that is efficient, replicable, and relatively inexpensive. Finally, the study will provide important research opportunities for WSU and WMU graduate students in the areas of social work, statistics, and geography.

The study is expected to have an equally broad range of applications. Day and Curtis anticipate it will show the need for, and feasibility of, cross-system data analyses that preserve and track health information of foster care youth, while also informing an existing federal initiative to revise policy on the types of data that are captured on youth in the foster care system. The geographic data mapping will help Michigan identify counties with underserved foster youth for targeted resource deployment and interventions, and improve the overall health of foster youth across the state. Finally, the study will help determine whether a managed care system is helping the state economize on services for foster youth, who account for 25-41% of Medicaid program expenditures despite representing less than three percent of all enrollees.

"Social work is about improving health and well-being through systems change," Day said. "If this study shows that Michigan can improve outcomes for kids at a savings to taxpayers, the state will be more likely to sustain and preserve these benefits for future generations of foster youth."