Prevention Science Institute, University of Oregon, Eugene, OR, USA.
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Matern Child Health J. 2021 Dec;25(12):1903-1912. doi: 10.1007/s10995-021-03270-9. Epub 2021 Oct 19.
Given recent advances toward universal screening for Adverse Childhood Experiences (ACEs), our objective was to investigate whether children with higher ACEs experience poorer quality of provider care and greater challenges accessing needed mental health treatment.
This study uses a nationally representative sample of US children aged 0-17 years drawn from the National Survey on Children's Health for 2016-2019. Caregivers and parents completed surveys between June 2016 and February 2020 (N = 131,774). Logistic regression models adjusting for identified covariates were used to test associations between a child's number of ACEs, their quality of provider care, and their access to mental health treatment. All analyses used appropriate survey weighting commands.
High ACEs (4 or more) were associated with lower quality of provider care, including effective care coordination [OR 0.45, 95% CI (0.38, 0.52)], family-centered care [OR 0.49, 95% CI (0.41, 0.58)], shared decision making [OR 0.50, 95% CI (0.39, 0.85)], and referrals for care [OR 0.58, 95% CI (0.43, 0.80)]; children with high ACEs were also less likely to have a medical home [OR 0.66, 95% CI (0.57, 0.76)]. High ACEs were also significantly associated with greater difficulty accessing mental health treatment [OR 0.55, 95% CI (0.43, 0.70)]. Similar results were found for children in the moderate ACE (2-3) and low ACE (1) groups.
Findings indicate that greater ACEs were associated with poorer quality medical care and greater difficulty accessing needed mental health treatment. Because findings indicate that children with high ACEs may be the least likely to receive quality care or necessary mental health treatment to address this adversity, universal screening for ACEs should be considered with caution.
鉴于最近在开展针对不良童年经历（ACEs）的普遍筛查，我们旨在研究 ACEs 较高的儿童是否经历较差的医疗服务质量和更难获得所需的心理健康治疗。
本研究使用了来自 2016-2019 年全国儿童健康调查的美国 0-17 岁儿童的全国代表性样本。照料者和家长在 2016 年 6 月至 2020 年 2 月期间完成了调查（N=131774）。使用调整了已识别协变量的逻辑回归模型来检验儿童 ACE 数量与其医疗服务质量和获得心理健康治疗之间的关联。所有分析均使用了适当的调查加权命令。
高 ACEs（4 个或更多）与较差的医疗服务质量相关，包括有效的护理协调[比值比（OR）0.45，95%置信区间（CI）（0.38，0.52）]、以家庭为中心的护理[OR 0.49，95% CI（0.41，0.58）]、共同决策[OR 0.50，95% CI（0.39，0.85）]和护理转介[OR 0.58，95% CI（0.43，0.80）]；ACEs 较高的儿童也不太可能有医疗之家[OR 0.66，95% CI（0.57，0.76）]。高 ACEs 与获得心理健康治疗的难度显著相关[OR 0.55，95% CI（0.43，0.70）]。在 ACE 中等（2-3）和 ACE 低（1）组的儿童中也发现了类似的结果。
研究结果表明，ACEs 较多与较差的医疗服务质量和更难获得所需的心理健康治疗相关。由于研究结果表明，ACEs 较高的儿童可能最不可能获得优质护理或必要的心理健康治疗来应对这种逆境，因此应谨慎考虑对 ACEs 进行普遍筛查。
