A Comparison of the Toxic Stress and Relational Health Frameworks
| . | Toxic Stress . | Relational Health . |
|---|---|---|
| Definition | Toxic stress refers to the biological processes that occur after the extreme or prolonged activation of the body’s stress response systems in the absence of SSNRs. | Relational health refers to the capacity to develop and sustain SSNRs, which in turn prevent the extreme or prolonged activation of the body’s stress response systems. |
| Contribution | Toxic stress explains how a wide range of ACEs become biologically embedded and alter life-course trajectories in a negative manner. | Relational health explains how SSNRs buffer adversity and promote the skills needed to be resilient in the future. |
| Approach to clinical care | Toxic stress is a deficits-based approach because it is focused on the problem: those biological processes triggered by significant adversity in the absence of SSNRs. | Relational health is a strengths-based approach because it is focused on solutions: those individual, family, and community capacities that promote SSNRs, buffer adversity, and build resilience. |
| Primary preventions in the framework | Primary preventions in the toxic stress framework are focused on how to prevent the wide array of adversities that might precipitate a toxic stress response. | Primary preventions in the relational health framework are focused on how to universally promote the development and maintenance of SSNRs. |
| Secondary preventions in the framework | Secondary preventions in the toxic stress framework are focused on identifying individuals at high risk for poor outcomes resulting from toxic stress responses by using population-based risk factors (eg, ACE scores) or emerging biomarkers (eg, methylation patterns). | Secondary preventions in the relational health framework are focused on identifying the potential individual, family, and community barriers to SSNRs by developing respectful and caring therapeutic relationships with patients, families, and communities. |
| Tertiary preventions in the framework | Tertiary preventions in the toxic stress framework are focused on the evidence-based practices that treat toxic stress-related morbidities such as anxiety, depression, oppositional defiant disorder, posttraumatic stress disorder, and substance abuse disorder. | Tertiary preventions in the relational health framework are focused on the evidence-based practices such as ABC, CPP, or PCIT that repair strained relationships and assist them in becoming more safe, stable, and nurturing. |
| Summary | Toxic stress defines the problem. Toxic stress explains how many of our society’s most intractable problems (disparities in health, education, and economic stability) are rooted in our shared biology but divergent experiences and opportunities. | Relational health defines the solution. Relational health explains how the individual, family, and community capacities that support the development and maintenance of SSNRs also buffer adversity and build resilience across the life course. |
| . | Toxic Stress . | Relational Health . |
|---|---|---|
| Definition | Toxic stress refers to the biological processes that occur after the extreme or prolonged activation of the body’s stress response systems in the absence of SSNRs. | Relational health refers to the capacity to develop and sustain SSNRs, which in turn prevent the extreme or prolonged activation of the body’s stress response systems. |
| Contribution | Toxic stress explains how a wide range of ACEs become biologically embedded and alter life-course trajectories in a negative manner. | Relational health explains how SSNRs buffer adversity and promote the skills needed to be resilient in the future. |
| Approach to clinical care | Toxic stress is a deficits-based approach because it is focused on the problem: those biological processes triggered by significant adversity in the absence of SSNRs. | Relational health is a strengths-based approach because it is focused on solutions: those individual, family, and community capacities that promote SSNRs, buffer adversity, and build resilience. |
| Primary preventions in the framework | Primary preventions in the toxic stress framework are focused on how to prevent the wide array of adversities that might precipitate a toxic stress response. | Primary preventions in the relational health framework are focused on how to universally promote the development and maintenance of SSNRs. |
| Secondary preventions in the framework | Secondary preventions in the toxic stress framework are focused on identifying individuals at high risk for poor outcomes resulting from toxic stress responses by using population-based risk factors (eg, ACE scores) or emerging biomarkers (eg, methylation patterns). | Secondary preventions in the relational health framework are focused on identifying the potential individual, family, and community barriers to SSNRs by developing respectful and caring therapeutic relationships with patients, families, and communities. |
| Tertiary preventions in the framework | Tertiary preventions in the toxic stress framework are focused on the evidence-based practices that treat toxic stress-related morbidities such as anxiety, depression, oppositional defiant disorder, posttraumatic stress disorder, and substance abuse disorder. | Tertiary preventions in the relational health framework are focused on the evidence-based practices such as ABC, CPP, or PCIT that repair strained relationships and assist them in becoming more safe, stable, and nurturing. |
| Summary | Toxic stress defines the problem. Toxic stress explains how many of our society’s most intractable problems (disparities in health, education, and economic stability) are rooted in our shared biology but divergent experiences and opportunities. | Relational health defines the solution. Relational health explains how the individual, family, and community capacities that support the development and maintenance of SSNRs also buffer adversity and build resilience across the life course. |