Screening for ACEs and responding with evidence-based interventions and trauma-informed care can prevent and treat toxic stress to improve patients’ physical and mental health.
Screening for ACEs involves assessing for exposure to adversity (using the ACE score), clinical manifestations of toxic stress (ACE-Associated Health Conditions), and protective factors. Clinical teams should use the ACEs and Toxic Stress Risk Assessment Algorithm to assess whether a patient is at lower, intermediate, or higher risk for having a toxic stress physiology.
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Clinicians routinely gather information from patients about their medical history, family history, and any specific health concerns during the primary care visit. Incorporating ACEs and toxic stress into the conversation involves reviewing the patient’s ACE screening results, asking about protective factors – including toxic stress mitigation strategies – that may be present, and taking note in the physical exam of any neurologic, endocrine, metabolic, or immune findings that could be associated with ACE-Associated Health Conditions.
Conducting the Clinical Assessment
Using the information gathered – including the ACE score and indications of ACE-Associated Health Conditions – clinicians use the ACEs Aware ACEs and Toxic Stress Risk Assessment Algorithm to assess the patient’s risk for toxic stress. Taken together, the ACE score and ACE-Associated Health Conditions indicate if a patient is likely to be at lower, intermediate, or higher risk for toxic stress physiology.
Developing the Clinical Response
The clinical response is informed by the patient’s risk for toxic stress in the clinical assessment and the protective factors that are in place, including the presence of toxic stress mitigation strategies.
The clinical response involves providing the following based on the level of risk of toxic stress:
- Patient education about toxic stress and its likely role in ACE-Associated Health Conditions;
- Clinical interventions and support services, including evidence-based toxic stress mitigation strategies (which starts with the clinician but may be supplemented by the broader clinical team within the clinic/system and/or by community-based organizations); and