Tina Cain posted:Is the goal to simply screen or is it preventing the negative emotional, physical and social outcomes that come from exposure to toxic stress? That should be a question, I think.
Jack Schonkoff, one of the authors on the original policy statement about Toxic Stress published in 2012 in Pediatrics, states that we have to be careful about developing biological markers that can be used to identify toxic stress in individuals because of the potential for misuse but a score in an electronic medical chart that is being used as a proxy for a biological marker (the ACE Score), which will not be able to be removed from the medical record once it is there has the potential to be misused too. That’s something that should be considered.
On average, it will be the poor and disadvantaged in society who will have the highest ACE score and that leaves the poor and disadvantaged the most vulnerable to misuse of this data.
Hi Tina, excellent point. I have seen some information about "allostatic load" - a (developing) battery of biological measures related to the stress response system - providing a potential more personalized/direct measure of the impact toxic stress. If this biological measure can be shown to be a valid measure of the accumulative impact of toxic stress then this could be used to complement an ACE screening (perhaps screening out those for whom ACE has not translated into relative increase in poor health outcomes).
Sample article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163075/