Household Adversity and Mental Health Access: The Impact of Parent and Healthcare Provider Communication on Unmet Needs Among Children

Background and Purpose:

Unmet mental health needs among children are a persistent concern, particularly for those exposed to household-based adverse childhood experiences (ACEs). Children with ACEs face increased psychological distress, yet they often remain disconnected from services. While prior research has documented the link between ACEs and unmet mental health needs, less is known about the role of modifiable factors, such as the quality of parent-healthcare provider communication quality, in mitigating these disparities. This study examined the independent associations of household-based ACE exposure and parent-provider communication with unmet mental health needs in a nationally representative sample of U.S. children.

Methods:

Data were drawn from the 2022–2023 National Survey of Children’s Health (NSCH), a nationally representative, cross-sectional survey of households with children aged 0–17 years. The analytic sample included 73,512 children ages 3–17. The primary outcome was parent-reported unmet need for mental health services in the past 12 months. ACE exposure was operationalized as a count of household-based adversities (parental divorce, death, incarceration, mental illness, substance use, or witnessing violence), categorized as 0, 1, or 2 or more. Parent-provider communication quality was assessed using a four-level composite (very low, low, medium, high), based on two NSCH items evaluating whether providers gave needed information and made parents feel like partners in their child’s care. Survey-weighted logistic regression models estimated the association between ACE exposure and parent-provider communication with unmet mental health need, adjusting for child age, sex, poverty level, race/ethnicity, and insurance type.

Results:

After adjusting for covariates, children exposed to two or more ACEs had significantly higher odds of unmet mental health needs (OR = 3.64, 95% CI = 2.89–4.60) compared to those with no ACEs. One ACE was also associated with increased odds (OR = 1.89, 95% CI = 1.47–2.43). In contrast, parent-provider communication quality was a strong protective factor. Compared to very low communication, children whose parents reported high-quality communication had 86% lower odds of unmet need (OR = 0.13, 95% CI = 0.10–0.17), with a clear gradient across communication levels. Public-private insurance coverage, older age, and poverty were also associated with increased odds of unmet need, while race and sex were not significantly associated.

Conclusions and Implications:

This study underscores the persistent impact of childhood adversity on access to mental health services but also identifies a key modifiable protective factor: parent-provider communication. Findings suggest that strengthening communication practices in pediatric care could reduce unmet mental health needs, even among children facing high levels of adversity. Trauma-informed, family-centered care models that prioritize relational engagement may be critical in addressing service disparities and improving mental health outcomes for vulnerable children. Social workers and health professionals can play a central role in advancing these communication-based interventions and advocating for systems-level change.