Online Program

Adverse childhood experiences: Understanding association with child health outcomes and access to quality health care using a lifecourse perspective

Monday, November 4, 2013

Christina Bethell, PhD, MBA, MPH, Department of Pediatrics, School of Medicine, The Child and Adolescent Health Measurement Initiative, Oregon Health & Science University, Portland, OR
Neal Halfon, MD, MPH, Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, CA
Paul Newacheck, DrPH, Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA
Paula Braveman, MD, MPH, Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA

Eva Hawes, MPH, CHES, Department of Pediatrics, School of Medicine, The Child and Adolescent Health Measurement Initiative, Oregon Health & Science University, Portland, OR
The Adverse Childhood Experience (ACE) Study found significant association between childhood abuse, neglect and exposure to violence with adult health problems (Felitti et al, 1998). A modified version of the adverse childhood experiences list was newly included in the embargoed 2011/12 National Survey of Children's Health (2011/12). National and state level ACEs prevalence will be calculated across a range of child subgroups and states. Multi-level and logistic regression models will examine associations between ACEs, demographics and health care quality measures (health care visits, mental health care, family-centered care, and medical home). National and state-level prevalence of ACEs will be calculated based on the nine individual items, in addition to analysis of composite score for ACE criteria. Demographic prevalence and child's health status will be explored for association with ACE score, including presence of emotional, behavioral or developmental problems. Access and quality of healthcare will be explored as potential mediators between ACEs and child health outcomes, taking into account other child and family characteristics; including insurance status, insurance adequacy, medical home, family-centered care, access to mental health care and access to specialty care. Understanding psychosocial risks and protective factors is essential to improving and constructing programs that promote early detection and timely interventions that support the well-being of all children. Differential impact on subgroups and associations with outcomes is expected to document the importance of assessing ACEs to improve state policy and program management and intervene early to help children achieve healthy development across the lifespan.

Learning Areas:

Program planning
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Evaluate national prevalence and variations in Adverse Childhood Experiences (ACEs) within the 2011/12 National Survey of Children’s Health Describe associations with other health and healthcare access and quality indicators at the child and state levels. Analyze state policies and program management programs that can be used to intervene and promote healthy development.

Keyword(s): Child Health, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Director of The Child and Adolescent Health Measurement Initiative (CAHMI) and Data Resource Center for Child and Adolescent Health, where our mission is to advance a patient-centered health care system. I serve as principle investigator for the collaborative development, validation and implementation of health and health care quality tools. Additional expertise in the development of systems of care that address the early socioemotional factors essential to promoting healthy development over the life course.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.