. 2022 Nov 14;10598405221135186.

doi: 10.1177/10598405221135186.

Online ahead of print.


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Gwendolyn D Childs et al.

J Sch Nurs.



For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the Academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child’s physical and mental health.


bullying; covid-19; mental health; school nurses; screening/Risk identification; social determinants of health; toxic stress.

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Application of the Toxic Stress Schema: An Exemplar for School Nurses