Mental health continuum of care for children with adverse childhood experiences (ACEs)

This evidence synthesis examined 21 qualitative studies about children’s experiences with ACE-related mental health services. Children and their families reported multiple barriers to accessing support services. This included reluctance to seek help due to shame or stigma, difficulties navigating complex service systems, re-traumatising experiences when they attended services and lack of workforce capacity. Children were more likely to engage with services that prioritised trust-building, relational safety and flexible care.

Why is this important?

• Effective support for children and young people with adverse childhood experiences (ACEs) is critical to preventing, reducing and managing psychological, emotional and behavioural impacts.
• The importance of trauma-informed and developmentally appropriate mental health services is well-recognised. However, more information is needed about how to improve engagement with services and the continuity of care across different stages of development for young people with ACEs.

What did they do?

• This paper describes a qualitative evidence synthesis of 21 peer-reviewed studies that focused on children’s experiences with ACE-related mental health services.
• The authors sought to understand factors that influence how young people experience mental health services or interventions following ACEs, including how they perceive service effectiveness; barriers and facilitators to care; and continuity of care across key developmental transitions (e.g. childhood to adolescence, school-based to specialised supports).
• The authors conducted a thematic synthesis guided by a framework to describe how young people with ACEs navigate, access and engage (or disengage) with mental health services over time.

What did they find?

• Many children affected by ACEs, and their families, did not seek support services because they did not recognise needs related to trauma or felt unable to seek help due to fear of disclosure or shame.
• Common barries to accessing services included not knowing what services were available, difficulties navigating complex service systems, long wait lists for specialist services and a lack of trauma-informed care providers.
• Some children and young people had experiences that were distressing or re-traumatising when they attended services. This included dismissive or judgemental behaviour of practitioners.
• Children and young people were more likely to engage with services that prioritised trust-building, relational safety and flexible care.
• System-level barriers also hindered engagement. These included workforce shortages, lack of trauma-informed practitioners, limited availability of specialised services and cultural barriers.
• Many young people turned to informal support from peers, teachers and online resources when formal services were inaccessible.

What does this mean for practice?

• The findings of this evidence synthesis highlight the need for policies and practices that support the involvement of parents and other important adults in a child’s life (e.g. those working in early childhood education and care, schools, family support services) in identifying and responding to signs of trauma.
• Practitioners and organisations should understand how to work in trauma-informed ways and embed trauma-informed practice into their services and day-to-day work. Organisations should provide ongoing staff training and embed policies that look after staff wellbeing to try and reduce high staff turnover.
• Practitioners can encourage successful engagement with children and families by providing care that is consistent, empathetic and not rushed. It is important that children and families understand the purpose of the service or session and that children can express themselves in ways that suit them (e.g. some children may prefer drawing or non-verbal methods).

This summary is one of the child mental health research highlights for May 2026, prepared by the Australian Institute of Family Studies (AIFS).