A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage

Published:October 06, 2021DOI:


      The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities.


      Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the “stress superstorm” of 2020 had on children of color based on their family's position on the advantage–disadvantage continuum.


      The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy.


      The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing


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      Felesia R. Bowen, Professor and Associate Dean for Diversity, Equity, and Inclusion, The University of Alabama at Birmingham School of Nursing, Birmingham, AL.


      Linda A. Lewandowski, Dean and Vice-Provost for Health Affairs, University of Toledo College of Nursing, Toledo, OH.


      Julia A. Snethen, Professor and PhD Program Director, University of Wisconsin-Milwaukee, Milwaukee, WI.


      Gwendolyn Childs, Associate Professor and Associate Dean for Undergraduate and Prelicensure Education, University of Alabama at Birmingham School of Nursing, Birmingham, AL.


      Freida H. Outlaw, Executive Academic Consultant, Substance Abuse and Mental Health Services Administration, Minority Fellowship Program, American Nurses Association, Silver Spring, MD.


      Cindy S. Greenberg, Dean, College of Health and Human Development, California State University, Fullerton, CA.


      Pamela J. Burke, LEAH Program Faculty/Senior Advisor for Nursing, Boston Children's Hospital, Division of Adolescent & Young Adult Medicine, Boston, MA.


      Elizabeth Sloand, Professor, Johns Hopkins University School of Nursing, Baltimore, ML.


      Faye Gary, Medical Mutual of Ohio & Kent W. Clapp Chair and Professor of Nursing, Cleveland, OH.


      Janiece DeSocio, Professor of Nursing, Seattle University College of Nursing, Seattle, WA.