Mitigating Toxic Stress: How can systems work together to prevent its effects?

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 employed 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 investigated the role of these innovations in preventing and mitigating toxic stress among families receiving pediatric health care. We worked 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. We issued the following reports from this study:

The project staff and their colleagues have also published four journal articles from this study:

The Evaluating Community Approaches to Preventing or Mitigating Toxic Stress study was designed to increase understanding of how to build integrated systems with coordinated services that promote healthy development of young children. We also partnered 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 included deepening our understanding of family experiences of health care and toxic stress through detailed analysis. We matched 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 examined:

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

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

Chapin Hall collaborated 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 JPB Foundation funded the work.

For more information about this initiative, please contact us at