Associations between Adverse Childhood Experiences and Need and Unmet Need for Care Coordination

Area of Science:

• Pediatric Health
• Public Health
• Health Services Research

Background:

• Children exposed to adverse childhood experiences (ACEs) often interact with multiple healthcare and social systems.
• Care coordination (CC) is crucial for optimizing health outcomes in children with special healthcare needs, who frequently navigate complex care systems.
• The association between ACEs and the need for, or unmet need of, CC remains under-explored.

Purpose of the Study:

• To investigate the relationship between adverse childhood experiences (ACEs) and the need for, and unmet need of, care coordination (CC) among children in the United States.
• To identify specific ACEs that are significantly associated with increased need and unmet need for CC.

Main Methods:

• Utilized data from the 2016-2017 National Survey of Children's Health, including 39,219 children.
• Employed weighted logistic regression analyses to examine associations between nine ACE types, ACE score, and the need/unmet need for CC.
• Identified children who accessed at least one healthcare provider in the preceding 12 months.

Main Results:

• Material hardship, parental mental illness, and neighborhood violence were significantly associated with a higher need for CC.
• Material hardship was also linked to an unmet need for CC.
• Children with higher ACE scores (1-3 or ≥4) demonstrated increased odds of needing and having unmet needs for CC compared to those with zero ACEs.

Conclusions:

• Both specific types of ACEs and higher cumulative ACE scores are associated with an increased need for and unmet need of care coordination.
• Healthcare systems should consider the unique needs of children with ACEs when designing and implementing care coordination programs.
• Tailoring CC services to address the complexities arising from ACEs is essential for improving pediatric healthcare outcomes.