Kristin Kan1,2, Ruchi Gupta3,4,5, Matthew M Davis3,4,5,6,7, Nia Heard-Garris3,4, Craig Garfield8,9. 1. Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA. kkan@luriechildrens.org. 2. Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. kkan@luriechildrens.org. 3. Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 5. Department of Medicine, and Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA. 6. Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA. 7. Department of Preventive Medicine, Northwestern University, Chicago, IL, USA. 8. Division of Hospital-Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 9. Institute for Public Health and Medicine, and Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
Abstract
OBJECTIVES: To evaluate the association of exposure to adverse childhood experiences (ACEs) and being a child with special health care needs (CSHCNs), and risks of specific ACE exposures with CSHCN status. METHODS: An analysis of 91,219 children from the 2011-2012 National Survey of Children's Health. Multivariable logistic regression was used to compare the odds of CSHCN status based on total ACE exposure and on distinct types of ACE exposure. RESULTS: Overall, 20% of children met CSHCN criteria. Although 57% of children had no ACEs, 23% had experienced 1, 13% had experienced 2-3 ACEs, and < 1% had experienced 4 or more ACEs. The odds of CSHCN status increased by 38% with 1 ACE [adjusted odds ratio (aOR) 1.38, 95% confidence interval (95% CI) (1.25-1.52)], but with ≥ 4 ACEs, the odds of CSHCN status increased nearly threefold [aOR 2.95 (95% CI 2.54-3.45)]. Presence of mental illness in the family [aOR 2.12 (95% CI 1.89-2.38)], domestic violence [aOR 1.69 (95% CI 1.48-1.93)], and neighborhood violence [aOR 1.89 (95% CI 1.67-2.14)] were the ACEs most strongly associated with CSHCN status. CONCLUSIONS FOR PRACTICE: Each additional ACE exposure increased the likelihood of CSHCN status, and family and community-level ACEs were associated with increased risk for CSHCN status. The findings suggest that systems of care for CSHCN, including public health, health care, education, and social welfare, should incorporate supports for addressing ACEs among this population and a trauma-informed approach.
OBJECTIVES: To evaluate the association of exposure to adverse childhood experiences (ACEs) and being a child with special health care needs (CSHCNs), and risks of specific ACE exposures with CSHCN status. METHODS: An analysis of 91,219 children from the 2011-2012 National Survey of Children's Health. Multivariable logistic regression was used to compare the odds of CSHCN status based on total ACE exposure and on distinct types of ACE exposure. RESULTS: Overall, 20% of children met CSHCN criteria. Although 57% of children had no ACEs, 23% had experienced 1, 13% had experienced 2-3 ACEs, and < 1% had experienced 4 or more ACEs. The odds of CSHCN status increased by 38% with 1 ACE [adjusted odds ratio (aOR) 1.38, 95% confidence interval (95% CI) (1.25-1.52)], but with ≥ 4 ACEs, the odds of CSHCN status increased nearly threefold [aOR 2.95 (95% CI 2.54-3.45)]. Presence of mental illness in the family [aOR 2.12 (95% CI 1.89-2.38)], domestic violence [aOR 1.69 (95% CI 1.48-1.93)], and neighborhood violence [aOR 1.89 (95% CI 1.67-2.14)] were the ACEs most strongly associated with CSHCN status. CONCLUSIONS FOR PRACTICE: Each additional ACE exposure increased the likelihood of CSHCN status, and family and community-level ACEs were associated with increased risk for CSHCN status. The findings suggest that systems of care for CSHCN, including public health, health care, education, and social welfare, should incorporate supports for addressing ACEs among this population and a trauma-informed approach.
Entities:
Keywords:
Adverse childhood experiences; Children with special health care needs; Community health; Family health
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