Beyond overwhelmed: A new measure of the functional impact of toxic stress on parents of young children

Abstract Background Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

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The Mitigating Toxic Stress Study Design: Approaches to Developmental Evaluation of Pediatric Health Care Innovations addressing Social Determinants of Health and Toxic Stress

10.21203/rs.3.rs-48890/v2 ◽

2020 ◽

Author(s):

Julie S. McCrae ◽

JoAnn L Robinson ◽

Angeline K Spain ◽

Kaela Byers ◽

Jennifer L Axelrod

Keyword(s):

Health Care ◽

Young Children ◽

Social Determinants Of Health ◽

Chronic Stress ◽

Study Design ◽

Social Determinants ◽

Determinants Of Health ◽

Toxic Stress ◽

Developmental Evaluation ◽

Pediatric Health Care

Abstract Background. Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods. Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions. We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

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A DvT-based clinical assessment of toxic stress in young children

Drama Therapy Review ◽

10.1386/dtr_00074_1 ◽

2020 ◽

Vol 7 (2) ◽

pp. 207-221

Author(s):

David Read Johnson ◽

Renée Pitre ◽

Catherine Davis

Keyword(s):

Young Children ◽

Clinical Assessment ◽

Assessment Procedure ◽

Toxic Stress ◽

Ethical Considerations ◽

Childhood Experiences ◽

Adverse Childhood ◽

Physical Threat ◽

Prior Experiences

A clinical assessment procedure is described for identifying possible sources of toxic stress among young children (ages 3–10), using a semi-structured modification of Developmental Transformations. This modification consists of improvisational play combined with a pre-determined sequence of roles symbolic of common adverse childhood experiences of neglect or emotional or physical threat. While conducting this procedure, the therapist carefully observes the client’s responses within the play to note the presence of play disruptions (e.g. hesitation, shift of scene and/or emotional arousal). These shifts may arise from prior experiences that remain distressing to the client and might merit further exploration. A review of the literature concerning toxic stress and assessments of children (particularly those that are play-based), along with an illustration of the clinical assessment, are presented. Strategies for follow-up and early intervention possibilities are highlighted. Key ethical considerations of this procedure are also discussed.

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