Summary
Adverse childhood experiences (ACEs) have been associated with poor health and underuse of preventive health services. However, less is known about how ACEs are associated with quality of care that children receive, like care that involves shared decision-making. Using data from the 2021–2022 National Survey of Children's Health, authors analyzed the association between ACEs, both individual and cumulative, and (1) needing medical decisions made in the past 12 months and (2) three different measures of always receiving care that involved shared decision-making.
Findings: After accounting for confounders, the number of ACEs experienced and most individual ACE items were associated with higher odds of needing medical decisions made, and lower odds of receiving health care that involved providers always engaging in the three measures of shared decision-making. This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that ACEs are associated with lower quality health care. This can be particularly detrimental to children with a history of ACEs because they have a greater need for health care and are less likely to use many types of health care. Efforts to improve health care quality for all children will be of particular benefit to vulnerable groups, like those with a history of ACEs.