Clinical Assessment & Treatment Planning

It is well established that early identification and intervention are key to ameliorating the impacts of toxic stress and reducing the risk of negative health and social outcomes.

female technician in scrubs showing notes on a tablet to father holding infant

The ACE Screening Clinical Algorithm (ADA version) helps a provider assess whether a patient is at low, intermediate or high risk of a toxic stress physiology, and how to incorporate ACE screening results into clinical care and follow-up plans. The algorithm is based on a combination of both the ACE score and presence or absence of ACE-Associated Health Conditions.

The treatment strategy consists of education to help patients recognize and respond to the role past or present stressors may be playing in their current health conditions.

For both children and adults, addressing current stressors and enhancing networks of safe, stable and nurturing relationships and environments are associated with decreased metabolic, immunologic, neuroendocrine, and inflammatory dysregulation, and improved physical and psychological health.

Clinical response to identification of ACEs and increased risk of toxic stress should include:

  1. Applying principles of trauma-informed care including establishing trust, safety and collaborative decision-making
  2. Identification and treatment of ACE-Associated Health Conditions by supplementing usual care with patient education on toxic stress and strategies to regulate the stress response including:
    • Supportive relationships, including with caregivers (for children), other family members, and peers
    • High-quality, sufficient sleep
    • Balanced nutrition
    • Mindfulness and meditation
    • Mental health care, including psychotherapy or psychiatric care, when indicated
  3. Validation of existing strengths and protective factors
  4. Referral to needed patient resources or interventions, such as educational materials, social work, care coordination or patient navigation, community health workers, as well as the six pillars listed above
  5. Follow-up as necessary, using the presenting ACE-Associated Health Condition(s) as indicators of treatment progress