Pediatricians are Key for Screening and Referring to Address Childhood Adversity

Feb 15, 2023

In the latest episode of The Power of Prevention Podcast, host Christin D’Ovidio and guest Felicity Bernard, the Director of the New Hampshire Pediatric Improvement Partnership (NHPIP) discuss the benefits of engaging and teaching pediatric practitioners to screen and refer for trauma and toxic stress in children.

Toxic Stress in Children

three children playing with blocks in classroomSignificant events in childhood such as physical or emotional abuse, observing domestic abuse of a parent or caregiver, having an incarcerated parent, living in a home with someone experiencing mental illness or substance use disorder, and the impact of hunger and homelessness as a result of poverty can contribute to a condition known as toxic stress. Toxic stress responses may occur when children are exposed to significant amounts of adversity, can undermine healthy brain development, and may result in chronic health conditions. Without community and social support to intervene, these events can also damage a child’s sense of safety, stability, and bonding, often for the duration of their life.

We know when a child’s environment includes “the presence of at least one responsive adult who provides a sense of security and protection, the stress response doesn’t last for an extended period of time.” The good news is when healthcare providers take steps to identify the needs of children and families, they can help guide them to community resources that provide support for building resilience healing, and healthy outcomes.

“The NHPIP is educating pediatric practices to learn about adverse childhood experiences (ACEs) and recognize the signs and symptoms of toxic stress, how to screen and interpret results for ACEs and to refer to community services such as family resource centers, domestic violence crisis centers, mental health centers and community action programs.” said Patti Baum, Program Director at the New Hampshire Children’s Health Foundation.

Why the concentration on pediatric practices?

Required childhood well visits and immunizations present an opportunity for the provider, often a trusted person to the family and child, to screen for ACEs and address underlying needs. “This is the main reason we work with pediatricians and their teams to get as upstream as possible to screen, educate and support families in a routine way,” said Bernard. “But if they come in to address specific concerns, it’s often for unexplained stomach aches or headaches, ADHD, having difficulty concentrating, or feeling disorganized. Some children may present with anxiety, depression, or some generalized behavioral concern. Sometimes these may be symptoms of toxic stress.”

young boy at pediatrician with fatherPart of the education project is to work with the provider on the soft skills necessary to have difficult and personal conversations with family members and young patients. “Having a trusted medical provider endorsing these interventions, providing hope and education, can all help to heal and recover from trauma,” said Bernard.

As mentioned, providers are made aware of community resources that can further support the child and family. “Connecting to community partners and resources has been especially powerful,” said Bernard. “It builds that confidence of providers and helps them feel like they can address this because they’re not alone and they have options for continued care for what they uncover.”

To date, NHPIP has provided education for pediatric practices across the state and educated over 500 professionals about the connection between toxic stress and poor physical and mental health outcomes. NHPIP has also helped build knowledge of- and connection to- the many community-based resources available for family referrals. Support for this work is made possible by funding from the New Hampshire Children’s Health Foundation. The foundation’s mission is to improve the health and well-being of all children in the state, with a vision that all children thrive and reach their full potential. The foundation carries out its mission by funding projects such as this.

For more information about this and other topics, The Power of Prevention Podcast series is available on StitcherApple PodcastsSpotify, and Google Podcast, or at The Partnership’s website. You can subscribe to the series wherever you listen.


Felicity Bernard, MA, LCMHC

Felicity BernardFelicity is the Director of the NH PIP, and a licensed clinical mental health counselor who has worked in a variety of settings with others from multi-disciplinary backgrounds to address all aspects of clients’ lives and barriers to wellness. In her management roles, she has developed and implemented programs to respond to the mental health needs of the populations with which she has worked. She is experienced in quality improvement, providing high quality patient care with positive clinical outcomes, developing methodologies for evaluation, and utilizing technology solutions to increase efficient workflows. She is an experienced trainer and guide for other clinicians and professionals, helping them grow in their professional lives and their understanding of evidenced based models of care.

Patti Baum

patti-baum-headshotPatti serves as Program Director at the New Hampshire Children’s Health Foundation. She coordinates all aspects of the foundation’s grantmaking program, in addition to meeting with grantees, partners, and stakeholders to plan and strategize for improving the health of New Hampshire residents. Prior to the Children’s Health Foundation, Patti’s experience includes work in health promotion and disease prevention, reproductive health, and domestic and sexual violence.

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