How to Use Social Service Strategies to Address Toxic Stress

The child welfare system plays a critical role in identifying, investigating, and intervening to protect children facing abuse and neglect.

However, the child welfare system traditionally isn’t as focused on preventing abuse and neglect.

Because abuse and neglect are among the adverse childhood experiences (ACEs) associated with toxic stress and some of the most common and serious health and social conditions, the social services sector is needed to help prevent these experiences before they occur.

That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health.

She, along with numerous health and child welfare professionals, wants to engage a cross-sector approach to cut ACEs and toxic stress in half in a generation.

Salud America! is exploring the report as part of its 11-part series on toxic stress.

Below are primary prevention, early detection, and early intervention strategies for the social services sector to address ACEs and toxic stress among Latino and all people.

Primary Prevention Strategies in Social Services

Primary prevention includes efforts that target healthy individuals and aim to prevent harmful exposures and behaviors from ever occurring.

This starts with acknowledging and addressing the foundation socioeconomic and environmental factors that shape the day-to-day conditions in which families live.

Key strategies include:

  • Reduce poverty and improve economic stability through increased access to safety net supports
  • Increase social connections through Family Resource Centers and community events
  • Improve neighborhood safety and play areas for children
  • Improve access to high-quality child and early care to support school readiness
  • Improve access to healthcare
  • Increase family-friendly work environments, such as paid sick and family leave and onsite child care
  • Increase public awareness and support for a shared community responsibility for child well-being

This important because nearly three times as many children face abuse and neglect each year beyond what is recorded by Child Protective Services (CPS).

Not only are children joining the child welfare system with histories of trauma, but some children are never identified thus don’t receive intervention.

It’s worse during COVID-19 because some of the major drivers of child welfare involvement, such as financial insecurity, unaddressed mental health challenges, and substance abuse, are worse during COVID-19. Moreover, due to school closures and physical distancing children are not exposed to stable adults that provide buffering supports or report abuse.

Some groups of children are impacted more than others.

Although estimates suggest that one in eight U.S. children will have experienced confirmed abuse and neglect by age 18, it is important to prioritize strategies for families with young children because young children are the most likely to experience substantiated abuse and/or neglect.

“In California, nearly half (45%) of children who have experienced substantiated child abuse or neglect were five years of age or younger,” Burke Harris’ report states.

It is also important to prioritize strategies for Latino, Black and Native American families because these children face higher rates of substantiated child abuse and neglect than white children.

Equitable policies and systems, as well as trauma-informed policies and systems, are important to level the playing field and provide safe, stable, nurturing relationships and environments for all children.

For example, the California Department of Social Services (CDSS) developed a racial equity tool to apply to policy development and program implementation.

They also formed an Office of Equity to:

  • expand services for people with disabilities
  • provide services in multiple languages
  • review data to better understand who CDSS serves and how they are served
  • learn about racial equity
  • enforce our civil rights laws
  • support the work of Tribal, Immigrant, or Refugee programs
  • contract with providers to increase services to underserved populations
  • diversify the workforce and create an inclusive environment that engages and partners with community

“Because implementing a trauma-informed systems approach involves considerable changes in policies and practice, agency leadership and middle management must be committed to the changes and actively engage in the process for it to be successful,” Burke Harris’ report states.

Early Detection Strategies in Social Services

Early detection aims to identify risk factors and build protective factors.

While in the healthcare sector early detection is typically accomplished through screening, in the social services sector, early detection is accomplished through identification of risk factors and promotion of protective factors.

For example, families dealing with substance abuse and young parental age would be targeted for social services and resources to build protective factors to mitigate or eliminate risk.

Services and resources include family-centered substance abuse treatment, home visiting programs, accessible Family Resource Centers, and respite care for families in crisis or with children with special needs.

Three organizations in California, including Para Los Niños in Los Angeles, are being trained through the Celebrating Families curriculum, which is a train-the-trainer model for a trauma-informed skill-building program for families with a parent with a substance use disorder.

How to Use Social Service Strategies to Address Toxic StressAfter all, parents with substance use disorders often have a history of ACEs themselves; thus it is critical to build protective factors among these vulnerable families to break the intergenerational cycle of trauma.

More than 30 states use an assets-based, evidence-informed approach known as the Strengthening Families framework to focus on the following five protective factors:

  • Parental resilience
  • Social connections
  • Knowledge of parenting and child development
  • Concrete support in times of need
  • Social and emotional competence of children

Additionally, as an alternative to formal CPS involvement, differential response programs to provide concrete services, like food and transportation assistance, can support families experiencing serious parental stress and prevent potential abuse and neglect.

Early Intervention Strategies in Social Services

Early intervention includes efforts that target families where abuse or neglect has already occurred to reduce the negative impacts and prevent recurrence.

Children in foster care represent a population at high risk for experiencing toxic stress and the neuroendocrine-immune-metabolic dysregulation it produces.

Combined with the emotional, physical, and social disruptions, these children are at risk for numerous negative health and social impacts.

“Human service agencies need to understand the impact of traumatic experiences on client functioning and mitigate the potential re-traumatizing effects of their own service systems,” Burke Harris’ report states.

Trauma-informed training can take multiple forms to address the diverse needs of adult learners. For example, trainings can be implemented in five-minute microlearning activities; webinars or presentations; or multi-day, in-person trainings.

Strategies to support families and children involved in the child welfare system include:

  • Accelerated bursts of intensive family preservation services with trained mental health counselors
  • Parent mentorship programs, with stable families providing support and acting as role models to families in crisis
  • Parent support groups that help transform harmful practices and beliefs into more positive parenting practices and beliefs

When necessary, child welfare organizations should connect children, youth, and families to pediatricians or primary care clinics that specialize in the foster care community and are trained to recognize and respond to toxic stress.

Additional services may include trauma-informed clinical interventions to regulate the stress response, such as:

  • mindfulness practices
  • improved nutrition
  • sleep
  • exercise
  • enhancing healthy relationships
  • access to nature
  • psychotherapy and other mental healthcare when necessary

What Can We Do About Toxic Stress?

Share our Salud America! team’s 11-part exploration into the important recommendations in Dr. Nadine Burke Harris’ roadmap to address ACEs and toxic stress:

  1. Toxic Stress and its Lifelong Health Consequences. Toxic stress is a public health crisis that has lifelong impacts on physical, mental, and behavioral health.
  2. We Need to Recognize Toxic Stress as a Health Condition with Clinical ImplicationsHealth experts are pushing to elevate toxic stress and developmental trauma on national research and policy agendas.
  3. Cut Toxic Stress with 3 Types of Public Health Prevention InterventionsPreventing toxic stress requires a three-level public health intervention approach.
  4. How to Use Healthcare Strategies to Address Toxic StressIn clinics, hospitals, and other healthcare settings, workers can provide universal trauma-informed care and more.
  5. Using Public Health Strategies to Address Toxic StressWhen it comes to ACEs and resulting toxic stress, the public health sector can play a critical role by strengthening economic support, positive family relationships, and social services.
  6. How to Use Social Service Strategies to Address Toxic Stress. We need trauma-informed training for social workers, as well as family-friendly workplaces and home visits. (current article)
  7. Toxic Stress in Early Childhood and How to Address It. Early childhood is a key time for preventing ACEs and toxic stress. (coming Feb. 18, 2021)
  8. Toxic Stress in Education and How to Address It. ACEs and toxic stress can hinder a person’s learning and school success. (coming Feb. 22, 2021)
  9. Toxic Stress in Justice and How to Address It. Encounters with police are “intrinsically stressful and potentially traumatic,” especially for youth of color. (coming Feb. 25, 2021)
  10. California’s Epic Response to Toxic Stress and ACEs. California, already leading the nation in addressing ACEs, is making inroads to address toxic stress. (coming March 1, 2021)
  11. Let’s Make 2011 the Year of Health Toxic Stress. Here are ways you can take action to address toxic stress. (coming March 4, 2021)

“Success requires integration of complementary efforts across systems partners, including primary care providers, mental health and social service providers, and cross-sector leaders, including in education, justice, early childhood, public health, social services, and entities that regulate and pay for services,” Burke Harris’ report states.


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