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.
The ACEs and Toxic Stress Risk Assessment Algorithms (ADA version) help 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. 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
- 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
- ACEs Aware Self-Care Tool for Pediatrics (To Print)
- ACEs Aware Self-Care Tool for Adults (To Print)
- ACE Clinical Workflows, Algorithms, & ACE-Associated Health Conditions: Pediatric & Adults
- ACE Clinical Workflows, Algorithms, & ACE-Associated Health Conditions: Pediatric & Adults (ADA Version)
- Center for Youth Wellness and ZERO TO THREE – How to Reduce the Effects of ACEs and Toxic Stress
- Center for Youth Wellness and ZERO TO THREE – The Benefit of Supportive Relationships
- Center for Youth Wellness and ZERO TO THREE – Using Mindfulness
- Center for Youth Wellness and ZERO TO THREE – Improving Mental Health
- Center for Youth Wellness and ZERO TO THREE – Good Sleep Habits
- Center for Youth Wellness and ZERO TO THREE – Promoting Exercise