The American Academy of Nursing (the Academy) has listed the reduction of toxic stress associated with adverse childhood experiences (ACEs) as a top priority for improving the health of the population (Mason & Cox, 2014). Exposure to ACEs or trauma in childhood places children at higher risk for developing both short-term and long-term negative physical and psychological health outcomes (Horner, 2015). Toxic stress is defined as the prolonged activation of stress response systems in the absence of protective relationships (Center for Child Development, 2016). Research has shown that children who have protective factors that promote resilience to such stress do not experience negative consequences (AAP, 2012). In 2016 the Academy issued a policy statement to encourage partnerships between health care professionals and other child and family organizations advocating for policies that strengthen and expand access to programs and services for families at risk for toxic stress to help promote optimal mental health and well-being, including enhancing protective factors (Gross et al., 2016). This project exemplifies such a partnership.
Purpose: The purpose of this poster is to share the evaluation of the effectiveness of a community partnership to raise awareness of toxic stress in early childhood and increase resilience and protective factors in children and families. The evaluation process uses the Social Ecological Model guided by the Center for Disease Control (CDC) Six-Step Public Health Program Evaluation Framework.
Setting: The Early Childhood Council and the Early Childcare Center, designated by the American Academy of Pediatrics (AAP) as a promising medical home, located in a suburban city in northeastern United States, partnered in this endeavor. The multi-strategy toxic stress awareness intervention implemented over a 12-month period is serving approximately 150 children ages 2-5 years of primarily low or moderate income working families from culturally diverse backgrounds. The team consists of a Pediatric Nurse Practitioner (PNP) consultant, a school nurse, a social worker, the executive director, teachers, staff, families and interprofessional university students.
Summary of Intervention:
All staff received training in developmental assessment using the Ages & Stages Questionnaires (ASQ) with an emphasis on social emotional development. Family engagement is key to positive outcomes for children and families. Resources were created to ensure continuity of prevention education in the home, classroom and broader community utilizing social media. Families at risk meet with the social worker to develop individual family plans. A peer-mentoring program involving families as peer mentors is designed to reduce conflict, foster problem-solving skills, and promote healthy relationships within the family. Educational materials and learning activities are designed at all 4 levels of the Social Ecological Model- child, family, school, and broader community with emphasis on emergent literacy and current curricular threads on social emotional development and resiliency building in early childhood.
Outcomes: Indicators of success are evidenced against the performance standards of utility, feasibility, propriety, and accuracy. Multiple measures based on the six-step CDC process include parent and staff surveys, focus groups with key informants, curricular changes, and analyses of children’s stories and drawings. The results of Ages and Stages Social Emotional Questionnaires (ASQ-SE) administered at recommended intervals to identify children at risk are discussed.
Implications for Practice: Distinguishing principles between research and program evaluation methodology are outlined. Outcome evaluations, future plans, and implications for public health are discussed. Strategies to assist professionals to support children and families meet the challenges of addressing the effects of toxic stress and increasing awareness are explored. Suggestions on implementing similar comprehensive community program evaluation processes are shared.
Funding & Support:
The National Center on Early Childhood Health and Wellness’ (NCECHW): Early Childhood Education (ECE) /Medical Home Toxic Stress Learning Collaborative grant.
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