Associations between adverse childhood experiences and need and unmet need for care coordination

Abstract

Introduction Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with the need and unmet need for CC. Methods Use of the 2016–2017 National Survey of Children’s Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score, and need and unmet need for CC. Results In the sample ( N  = 39,219, representing 38,316,004 US children), material hardship (adjusted odds ratio (aOR), 1.50; 95% confidence interval (CI), 1.29–1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07–1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01–1.74) were significantly associated with an increased need for CC. Material hardship was also associated with an unmet need for CC (aOR, 2.37; 95% CI, 1.80–3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs. Discussion Specific ACE types and higher ACE scores were associated with the need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric health care system.