Developing a public health approach to toxic stress and transforming the medical home so it is integrated both vertically and horizontally will not happen overnight! That said, the following Key Tips provide some pointers on how to get started:
Acquiring Medical Knowledge
Communicating with Families
- Understand typical development and how to assess for deviations.
- Adopt an ecobiodevelopmental framework: It is the on-going and cumulative dance between the ecology and the genetic program that drives developmental outcomes across the lifespan.
- Read the Policy Statement and Technical Report on Toxic Stress to understand how the early childhood environment influences, for better or for worse, the way the genome is read and the developing brain is hardwired.
- Know the Adverse Childhood Experiences (ACE) Studies and the impact of childhood adversity and parental history on lifelong outcomes in behavior, health, and productivity.
- Acknowledge that safe, stable, and nurturing relationships (eg, the secure attachments manifest in the Circle of Security) quite literally “Build Brains and Forge Futures.”
- Understand the “Relationship as a Vital Sign” concept. Because the quality of the early parent-child relationship is so fundamental, social-emotional surveillance is a critical component of every visit.
- Discuss with parents and caregivers the pivotal and foundation role of the first 1000 days.
- Emphasize that early relationships need to be “safe, stable, and nurturing.” Parents and caregivers should therefore “Protect, Relate, and Nurture” – PRN all the time!
- Communicate and interact with parents and caregivers to provide anticipatory guidance that assists parents and caregivers in proactively building the critical social-emotional-language skills that buffer toxic stress. Examples include: Bright Futures, Connected Kids, the 6 Ps of Purposeful Parenting (Purposeful, Protective, Personal, Progressive, Positive and Playful), and the 5 Rs of Early Literacy: Reading, Rhyming, Routines, Rewards, and Relationships.
- Assess the social-emotional status of the family at every visit (“the Relationship as a Vital Sign” surveillance).
Build Systems and Connections within the Community
Develop collaborative relationships with the resources in your community that might assist parents and caregivers and prevent and/or mitigate the precipitants of childhood toxic stress.
- Home visitation programs (eg, Nurse Family Partnership)
- Early Intervention services
- Head Start
- Infant and early childhood mental health providers
- Parent/Family support systems (eg, Circle of Security, Triple-P, Nurturing Parenting, addressing illiteracy, unemployment, unsafe housing, food scarcity, Parent-Child Interaction Therapy)
- Legal Aid and medicolegal partnerships, child care networks/resource and referral agencies
- Community libraries, assistance for victims of domestic violence, care for parents with substance abuse or mental health issues
- Advocate for the development of resources to fill the gaps that exist in your particular community.
- Encourage consistent, community-wide messaging (prenatal, home visits, WIC, early intervention, preschools, early childhood PTAs, etc.) on issues related to early brain and child development (e.g., promoting Reach Out and Read, limiting screen time, alternatives to corporal punishment).
- Identify (and collaborate with) high quality early education and child care settings.