Toxic Stress Education for Pediatric Practitioners to Improve Health Outcomes

Abstract

Toxic stress associated with adverse childhood experiences during childhood can have catastrophic lifelong neurobiological, social, and emotional effects and has been shown to decrease life expectancy up to 20 years. More than 50% of children have experienced at least one adverse childhood experience. Present lifetime cost of child maltreatment in the United States is $210,012 per child. The purpose of the quasi-experimental study was to evaluate care outcomes associated with a professional education initiative using the CDC’s Essential of Childhood Framework. Study participants were recruited from all advanced practice registered nurses practicing in ambulatory clinics. The educational offering included didactics, case discussions, and presentation of the ACEs questionnaire for potential use in practice. A pre-test was given to assess beliefs related to psychosocial problems. Pre- and post-intervention screening and practice patterns were analyzed using the electronic medical record data. A total of 15 female Caucasian advanced practice registered nurses with a mean age of 40 participated in the study. Participant pre-intervention scores on the Physician Belief Scare indicated good awareness of psychosocial issues contributing to physical health, but no evidence of screening. A pre- and post-intervention electronic health record review for incidence of screening for toxic stress indicated a 71% increase. Post-intervention data revealed that the participants implemented toxic stress screening on a sometimes to often basis. The results of this study emphasize the importance of educational interventions to improve screening and intervention practices found in the research to improve population health.