Pediatric Psychosocial Preventive Health Model

Recently, pediatricians and pediatric nurses have been called to action to reduce the effects of adverse childhood experiences (ACEs) or toxic stress, by implementing a more trauma-informed approach to their practice. While asking a few leading questions to address ACEs, doctors and nurses should incorporate an awareness of traumatic stress reactions that may interfere with the children's health and functioning into their routine clinical encounters. In some cases, traumatic stress reactions can have serious implications for medical outcomes. It may be useful to think of preventing and treating traumatic stress reactions as a pyramid:

Universal (at the base): Most children and families need general information and support

Targeted (in the middle): A few higher risk or more distressed children and families need increased support and focused guidance to help them anticipate challenges and to strengthen their coping skills

Clinical (at the top): Finally, a much smaller group children and families need more extensive psychosocial support and evaluation or treatment by a mental health professional

This prevention intervention model suggests that doctors and nurses provide every child and family with basic support and information and regularly screen for acute distress and risk factors to determine which children and families and might need more support. What questions do you ask of your patients and families to assess ACEs or traumatic stress reactions?