Delivery of Care

Making the efforts to reduce toxic stress more visible

New resource guide creates an online source where data, research, initiatives and interventions converge

Courtesy of DataSparkRI

The first page of a four-page online resource guide, "Visualizing a Collaborative Strategy to Reduce Toxic Stress in Rhode Island: A work in progress."

Courtesy of DataSparkRI

Second page of the online resource guide, "Visualizing a Collaborative Strategy To Reduce Toxic Stress in Rhode Island." The effort was one of the outcomes developed as a result of a Oct. 28 conference at Rhode Island College.

Courtesy of DataSparkRI

The third page of an online resource guide, "Visualizing a Collaborative Strategy To Reduce Toxic Stress in Rhode Island." The guide was developed by DataSparkRI, working in partnership with the R.I. Department of Health, ConvergenceRI, the R.I. Alliance for Healthy Homes, and the Green & Healthy Homes Initiative.

Courtesy of DataSparkRI

The fourth page of the online resource guide, "Visualizing a Collaborative Strategy to Reduce Toxic Stress in Rhode Island," focused on healthy housing interventions.

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By Richard Asinof
Posted 11/30/15
A new online resource guide on collaborative efforts to reduce toxic stress in Rhode Island has been developed by DataSparkRI. The work in progress seeks to create a unified source for data, research, initiatives and interventions. The resource guide was created in partnership with the R.I. Department of Health, ConvergenceRI, the R.I. Alliance for Healthy Homes, and the Green & Healthy Homes Initiative.
When will toxic stress become a standard part of the medical school curriculum at the Warren Alpert Medical School at Brown University? As much as the Children’s Cabinet has been briefed on toxic stress, is there a way for a similar briefing to be held for the R.I. General Assembly? How can the ongoing neuroscience research being conducted at Brown University be more fully integrated into the activities of the Brown School of Public Health regarding early childhood development?
At the Thanksgiving extended family dinner table this year, a second-year medical student attending Yale answered the question why he was not considering a medical career in primary care in rapid-fire pronouncements: the lack of financial remuneration, the abysmal lifestyle, the lack of research opportunities, and the length of time he would be saddled with debt from his medical school education, which will approach $300,000 upon graduation. As much as the advocates of health care reform elevate the coordinated practice of primary care as a fundamental precept of transforming the health care delivery system, that call for action is not being heard by those pursuing a career in medicine. The 2015 R.I. Statewide Health Inventory found that the number of primary care physicians is 10 percent less than the national average for adequate access to care.

PROVIDENCE – A new online resource guide on toxic stress has been developed in partnership with DataSparkRI to help map out the numerous initiatives now under way in Rhode Island.

Entitled “Visualizing a Collaborative Strategy to Reduce Toxic Stress in Rhode Island: A Work in Progress,” the new guide is one of the outcomes of the conversation begun at the Oct. 28 event held at Rhode Island College. [See link below to ConvergenceRI story.]

The goal is to share the guide across numerous platforms, networks and agencies and community groups, to help illuminate the ongoing work.

The initial version was created through a collaborative effort involving the R.I. Department of Health, DataSparkRI, ConvergenceRI, the Green & Healthy Homes Initiative, and the Rhode Island Alliance for Healthy Housing.

The document is envisioned as a work in progress, where documentation, data and research can converge as part of an iterative process, according to its developers. The expectation is that the information will be updated, tweaked and expanded as the landscape changes and the efforts to reduce toxic stress in Rhode Island evolve.

Defining toxic stress
The converging efforts around reducing toxic stress in children – including a pediatric definition that identifies diagnosis, treatment and referral options – puts the focus on allowing Rhode Island’s children to grow up in conditions that allow them to achieve their full potential.

A new definition developed by the R.I. Department of Health, in partnership with the R.I. chapter of the American Academy of Pediatrics, says:

“Stress is a part of everyday life, and most of us do not have long-lasting problems adjusting to stress. To cope with everyday events, children invoke biological, psychological, social, and/or physical-action responses.”

In the face of adverse or traumatic events, the definition continues, “A child’s mobilized responses are more likely to be ineffective, resulting in the stress response remaining active. Such prolonged activation increases the potential for enduring changes in physiologic and neurologic systems.”

When such enduring changes compromise children’s adaptation, the definition concludes: “We refer to this long-term series of events as toxic stress.”

In addition to the pediatric definition of toxic stress, the visualization document includes:

• Evidence-based data produced by Rhode Island KIDS COUNT to track the health and well-being of children and the factors directly related to toxic stress;

• Information on 11 health equity zones in Rhode Island to address the reality that health comes from where you live, work, play and pray;

• Links to interventions developed for family visiting programs to help ameliorate the effects of many factors related to toxic stress;

• Healthy housing resources, a critical determinant of health for children and families; and

• Some details about neuroscience research efforts to identify the consequences of early life stress on brain development.

Convergence and conversation
The conversation and convergence around initiatives to reduce toxic stress puts renewed emphasis on addressing health equity and the social and economic determinants of health.

“Every child in Rhode Island deserves to grow up in conditions that allow them to achieve their full health potential and full life potential, no matter what zip code they come from. This means that we must address the underlying social and environmental determinants of health, including toxic stress,” said Dr. Nicole Alexander-Scott, director of the R.I. Department of Health.

Alexander-Scott praised the effort to establish a collaborative framework around the discussion of toxic stress, bringing neuroscientists, early childhood advocates, pediatricians, healthy housing advocates to the same table.

“Changes we make now can have real impacts for generations to come on the health of our communities and the health of our state as a whole,” she said.

Many rivers to cross
The introduction of toxic stress as a concept within Rhode Island’s health care delivery ecosystem is still very much in its infancy.

In recent interviews with ConvergenceRI, both Dennis Keefe, president and CEO of Care New England, and Neil Steinberg, president and CEO of The Rhode Island Foundation, asked clarifying questions about what was meant by toxic stress, as a way to better understand the concept. [See links below to ConvergenceRI articles.]

In her lecture, “Unpacking the Racial Disparities of Health,” Brown University President Christina Paxson alluded to the concept of stress as one of the key metrics involved with poor health outcomes, but did not venture into the realm of toxic stress, specifically. [See link to ConvergenceRI story below.]

Even at the kickoff of the Rhode Island Campaign for Grade-Level Reading, held at United Way of Rhode Island on Nov. 25, the connection between promoting greater proficiency in reading by children and toxic stress was not directly mentioned, except obliquely, in what was termed “the health determinants of early school success,” as supporting children’s healthy, social-emotional development and controlling environments and managing asthma. [More surprising, perhaps, was the fact that the connection between the damages caused by elevated levels of lead in children in Rhode Island and a lack of reading capability was not mentioned at the event.]

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