Mental health continuum of care for children and young people with adverse childhood experiences: A qualitative evidence synthesis

BACKGROUND: Supporting children and young people (≤24 years) who have experienced adverse childhood experiences (ACEs) is challenging due to limited access to specialized mental health services and systemic barriers that hinder continuity of mental health care. OBJECTIVE: This qualitative evidence synthesis investigated the pathways and continuum of mental health care among children and young people experiencing ACEs and mental health challenges. METHODS: Articles were identified through searches of electronic databases and manual searches of reference lists. The candidacy framework guided our thematic synthesis, focusing on how young people access, navigate, and remain engaged in mental health care. RESULTS: Twenty-one studies evaluated the health seeking practices for young people with ACEs. Many children and young people with ACEs do not seek treatment, and others discontinue care due to distress or alienation. Early help-seeking was often delayed due to low awareness, fear of disclosure, and parental reluctance. Access to services was limited by fragmented systems, logistical and financial barriers, and lack of information. Engagement was undermined by emotional discomfort, cultural or language barriers, re-traumatization risks, and negative provider attitudes, while sustained use depended on trust, culturally appropriate care, and service continuity. As a coping, many young people turned to informal support from peers, teachers, and online resources when formal services were inaccessible. Structural challenges, including insufficient training, weak referral pathways, and limited resources, further undermined continuity of care. CONCLUSIONS: Recognizing informal and alternative pathways, combined with integrated, contextually adapted, cross-sectoral care models, can help address unmet mental health needs of children and young people with ACEs globally.