Adverse Childhood Experiences, the Medical Home, and Child Well-Being

To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6–17 using the 2011–2012 National Survey of Children’s Health.

Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6–11 and adolescents 12–17.

Over half (53 %) of US children ages 6–17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6–11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home.

Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.