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

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.