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 Workflows, Risk Assessment and Treatment Algorithms, and ACE-Associated Health Conditions information (ADA version) helps providers assess whether a patient is at low, intermediate or high risk of a toxic stress physiology. The algorithm’s toxic stress risk assessment is based on a combination of both the ACE score and the 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 and addressing toxic stress physiology as a core component of treating ACE-Associated Health Conditions.

For both children and adults, addressing current stressors, increasing the total dose of buffering and protective factors such as safe, stable and nurturing relationships and environments are associated with decreased metabolic, immunologic, neuroendocrine, and inflammatory dysregulation, and improved physical and psychological health.

When treatment comes later in life, it is known that for individuals with ACEs, addressing the resulting toxic stress physiology is important for improving ACE-Associated Health Conditions, as well as for averting future consequences.

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. Supplementing usual care for ACE-Associated Health Conditions by providing patient education on toxic stress and offering 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
    • Regular physical activity
    • Mindfulness and meditation
    • Access to nature
    • Mental health care, including psychotherapy or psychiatric care, and substance use disorder treatment, 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 seven pillars listed above

5. Follow-up as necessary, using the presenting ACE-Associated Health Condition(s) as indicators of treatment progress