Step 2: Prepare Your Clinical Response

In Step 2, you will explore key considerations for ensuring your team is prepared to gather patient information and conduct the full clinical assessment related to ACEs and toxic stress. You will also begin to document your team’s clinical response to ACEs and toxic stress – including patient education, interventions, and access to additional support services.

Gather Information

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.

Conduct the Clinical Assessment

Using the information gathered – including the ACE score and indications of ACE-Associated Health Conditions – use the ACEs and Toxic Stress Risk Assessment Algorithm to assess the patient’s risk of toxic stress. Taken together, the ACE score and ACE-Associated Health Conditions indicate if a patient is likely to be at low, intermediate, or high risk for toxic stress physiology.

Determine the Clinical Response

The clinical response is informed by the risk of toxic stress identified in the clinical assessment as well as protective factors, including the presence of toxic-stress mitigation strategies. The clinical response may include:

1. Patient education about toxic stress and its likely role in ACE-Associated Health Conditions,
2. Intervention and support services; and
3. Follow up.

Clinical interventions and support services that promote toxic stress-mitigation strategies may be located within a clinic or system and/or through referrals to community-based organizations that are part of the Network of Care.

To Do: