Mitigating Toxic Stress

How can systems work together to prevent the effects of toxic stress?

Experiencing and learning how to manage stress is a normal part of child development. But when children experience stress for prolonged periods, without the supportive response of an adult, that stress can be toxic. What we’ve come to know as toxic stress can threaten children’s long-term well-being, with significant costs to our nation’s health and communities.

Pediatric primary care clinics are often the front-line to identifying families and children who may be experiencing toxic stress. In five communities, pediatric clinics are employing two innovations to promote family-centered care and better coordination between health care and community-based programs to prevent and mitigate toxic stress.

These innovations are:

Over a three-year period, Chapin Hall is investigating the role of these innovations in preventing and mitigating toxic stress among families receiving pediatric health care. We are working with healthcare clinics and early childhood service providers and more than 900 families with young children to capture how family experiences and outcomes are altered by these innovations. As of May 2020, six reports have been issued from this study:

The Evaluating Community Approaches to Preventing or Mitigating Toxic Stress study is designed to increase understanding of how to build integrated systems with coordinated services that promote healthy development of young children. We are also partnering with Help Me Grow (HMG) to describe how health care practices use community-based early childhood service referral mechanisms to assist families with needed resources.

Our work includes deepening our understanding of family experiences of health care and toxic stress through detailed analysis. We will match information collected from families about stressors, protective factors, and risks at three time points, with electronic health records, Medicaid claims, and service delivery registry data. With this information we will examine:

  • Changes in preventive service use and well-being for families over time
  • Improvements to pediatric health care quality using standardized indicators
  • Increased value and impact on health care cost through efficient use of prevention services

The study is also investigating the five communities’ approaches to embedding and sustaining the innovations over time. The participating pediatric primary care clinics are located in Alameda County, CA; Orange County, CA; Lamoille Valley and Burlington, VT; Los Angeles, CA; and Palm Beach County, FL.

This work is led by Dr. Julie McCrae, who brings considerable expertise in implementing and studying interventions in community settings. The Chapin Hall research team also includes Dr. Angeline Spain (qualitative lead researcher), Dr. Emma Monahan, and Angela Garza.

Chapin Hall is collaborating with NORC, the American Academy of Pediatrics, the Center for the Study of Social Policy, and Help Me Grow National Center to conduct the study, and with the early childhood systems and the pediatric primary care clinics. The work is funded by The JPB Foundation.

Throughout the study, we will release briefs, with a final report slated for 2021. For more information about this initiative, please contact us at