O2003: Utilization of Preventive Care and Emergency Department Visits in Children Exposed to Aces

Background: Adverse Childhood Experiences (ACEs) are associated with increased morbidity and mortality in the pediatric population. Children exposed to ACEs need at least equal amount of preventive care as those not exposed to ACEs. The aim of the study was to assess access to preventive care and ED utilization among children exposed to ACEs.

Methods: Secondary data analysis de-identified from the 2019 National Survey of Children’s Health, comparing the level of preventive care and Emergency Department (ED) visits in children 6 – 17 years of age exposed to ACEs with same age children not exposed to ACEs. ACEs was defined as- Parent or guardian divorced or separated, death, serving time in jail, children witnessed domestic violence, being a victim or witnessed violence in neighborhood, lived with anyone who has psychiatric illness, who had a problem with alcohol or drugs, or being a victim of discrimination based on race or ethnic group.
Outcome variables included access to preventive health services including general, vision, dental health as well as ED utilization. Frequencies and descriptive statistical analyses were used to describe the study variables. Cross tabulation analyses and co-relational analyses were used to examine relationships among predictor and outcome variables.

Results: Of 29,433 children who participated in survey, 20,666 met inclusion criteria. Of these, 8141 (39.4%) were exposed to various types of ACEs (figure 1). There was no statistical difference between child’s gender with regards to exposure of ACEs. Afro-American children had more exposure to ACEs than White and Asian children. Children exposed to ACEs are less likely to have a preventive health care visit in the last year, to identify a place to go to be seen when sick, to have a well establish health care provider for preventive care, to receive vision care and to have preventive dental care. They are also more likely to utilize the ED for care while being sick, to be admitted to the hospital during the last year and to use alternative medicine. Parents of children exposed to ACEs were more likely to perceive difficulty in obtaining needed health care services and in getting referral to specialists. (Table 1).

Conclusion: Children exposed to ACEs received less preventive care including general, vision and dental care. They are more likely to visited ED for sicknesses and to perceive difficulties in getting needed referrals. There is a need for increased access to needed health services (especially dental) & for optimizing coordination of care in US children with ACEs exposure.