P3C182: Screening for Toxic Stress Response and Buffering Factors: A Trauma-informed Approach to Health Equity

Background: Exposure to adverse childhood experiences (ACEs) can lead to a toxic stress response with impacts on health that affect health equity. As part of our Health Equity, Social Justice, and Anti-racism curriculum, our aim was to introduce participants to a case-based method using a template-based screening and application of toxic stress, buffering factors, and resiliency-fostering tools to address health disparities and inequities with a trauma-informed care approach.

Methods: We developed an asynchronous e-learning module that demonstrated the impact of ACEs by introducing participants to screening for toxic stress response and buffering factors on health, their role as health equity determinants, and the use of brief point of care resilience-fostering tools in patient care. This was followed by a synchronous, facilitated, small-group, virtual discussion of a clinical case. Pre- and postworkshop surveys assessed changes in knowledge, skills, and attitudes. A 3-month follow-up survey assessed participants’ behavioral changes

Results: Sixty-four participants completed the learning module. Paired t-test analysis showed a statistically significant increase in knowledge, skills, and attitudes regarding the Educational Objectives, with a survey response rate of 98%. Participants commented favorably on the practical use of screening tools. Three months after the workshop, a third of participants were applying these concepts, with a survey response rate of 87%. After completing the workshop, participants reported that “the screening tools will be a game changer in the assessment of social determinants of health and their impact on health outcomes” and that “non-clinicians would be able to explain its use to improve patient outcomes.”

Conclusion: Implementing this case-based curriculum in trauma-informed care helped increase opportunities for equitable health in patient encounters by providing participants with the skills to screen for toxic stress, buffering, and brief point of care resiliency-fostering tools. As we emerge from the COVID-19 pandemic and its traumatic effects, using an approach of “What happened to you?” and an approach of “What's strong with you?” creates avenues to build relationship-centered care and incorporate Trauma Informed Care to maximize opportunities for equitable health in patients.